A 21 year-old male with repeat episodes of right lower quadrant pain for 4 months, was admitted. Retrograde double-balloon endoscopy (DBE) revealed the ileocecal valve was deformed with 10 cm tight stricture and a nearby internal fistula. The stricture and fistula were accompanied by ulcers, which led to a diagnosis of Crohn's disease. We attempted treatment with an elemental diet, mesalazine, and adalimumab. Retrograde DBE performed 3 months after starting treatment showed reduction in the stricture length and ulcers. Endoscopic balloon dilation (EBD) was then performed for the stricture. The dilation diameter at the first procedure was 8 mm. We repeated EBD at intervals of several months and gradually increased the dilation diameter to 15 mm. Retrograde DBE performed 7 months after starting treatment showed mucosal healing. Strictures with internal fistulas in patients with Crohn's disease has typically been managed by surgical resection. The present patient suggests that repeated EBD can avoid surgical resection if mucosal healing is promoted by medical treatment with a strict elemental diet.
