2020 Volume 45 Issue 3 Pages 244-249
A 45-year-old male who had been diagnosed as having Crohn’s disease 10 years earlier presented with an anal lesion. Infliximab was initially administered for treatment of the fistula, although with gradual decline of the drug efficacy, the therapy was switched to anti-drug antibodies (ADA). Following ADA treatment, the patient experienced episodes of ileus that sometimes necessitated hospitalization. Our examinations revealed stenosis as well as a fistula in the ileum, and surgery was scheduled. During the operation, the lesions in the terminal ileum were observed to have conglomerated into a single mass, with fistula formation and organic dilatation of the oral intestinal tract. An ileocecal resection was performed, after which we confirmed, by visual inspection and palpation, the absence of any residual lesion from the ligament of Treitz to the ileal end. The ileus tube was then removed and the operation completed. Following surgery, the patient failed to defecate and vomited for 4 days, for which he was given conservative treatment with decompression and placement of an ileus tube. However, as the condition did not improve, additional examinations were performed. Abdominal computed tomography revealed intussusception and a reoperation was performed, although removal of the intussusception was difficult and an ileal resection of 60 cm was required. Following that procedure, the condition of the patient improved and he was discharged. Although rare, prompt and appropriate treatment are very important in Crohn’s disease patients with intussusception.
