Case Presentation
Female Patient ABAged 20First seen by me in August 2009Had been diagnosed with Crohn’s Disease in
March 2009
DiagnosisInitially had presented with change in bowel
habit in March 09Referred for Ix and Ileocaecal Crohn’s
diagnosed after colonoscopy and biopsyMRI scan showed limited disease in ileum but
diffuse colonic involvement
Management
Initially treated with budesonide – some improvement in symptoms but suboptimal response
Then tried with prednisolone – good response but unpleasant SE – weight gain and hot flushes
Prednisolone gradually reduced – had a relapse so went back up on dose again
ManagementJune 09 Commenced on azathioprineNot well tolerated and had admission with
high temp, flu like symptoms and high WCC and platelets
Admitted for Infliximab infusion August 09Disappointing responseTrial of cholestyramine – not well tolerated
current presentation
Presented to me with one week history of increasing frequency of stools and abdominal cramps
BO 8-10 x/dayNo bloodMucous ++Interfering with work and quite tearful
What to do??
Examination – afebrile. Pulse 70 abdo soft. No masses. Tender RLQ.
Did bloods for FBC, ESRPrescribed prednisolone and review end of
week
Saw at end of week – bloods normal.Not taken steroids for fear of SESymptoms unchanged
What to do??
Spoke to Dr BebbDifficult management as not responding well
to medical treatmentFelt she would need surgery at some pointDue to be discussed at MDTSteroids may help in meantime
Next seen by me in August 2010Had a very eventful year
Had repeat colonoscopy October 2009Showed minor inflammation and ulceration of
the terminal ileumReferred for Surgical Management
Underwent laparoscopic ileocolic resection in February 2010
Complicated by post op collection treated with antibiotics
Continued to have diarrhoea and abdo painJune 2010, laparatomy, resection of
anastomosis and formation of ileostomy
Seen by me again August 2010Pregnant and requesting terminationOCP stopped due to major surgeryHad been told fertility probably lowSI on 2 occasions . Condom splitReferred for terminationActually had missed miscarriageCommenced on Depo for contraceptionAwaiting reversal of ileostomy