P3399 - Small Bowel Crohn's Disease Diagnosed on Exploratory Laparotomy

Daniel Conde, MD, Nathaniel Saffran, MD, Stephanie Socias, MD, Alexandra Gutierrez, MD
Columbia University Irving Medical Center, New York, NY

Introduction: Crohn’s disease is a type of inflammatory bowel disorder that can present with a wide constellation of symptoms. We present a case of penetrating small bowel Crohn’s disease diagnosed post small bowel resection for retrieval of retained video capsule.

Case Description/

Methods: A 64-year-old female with chronic constipation presented with iron deficiency anemia and 50 lb weight loss over 2 years. Colonoscopy showed moderate diverticula, TI was not intubated, and no biopsies were collected. EGD was unremarkable, and H. Pylori negative. Video endoscopy showed a small ulceration in the jejunum with capsule retention in terminal ileum after 8 hrs. Stool calprotectin 522 mcg/g, after video capsule retention. CT AP showed mesenteric lymphadenopathy with a 2.1 cm lesion and thickening of the small bowel loops. A follow up PET scan showed mildly increased FDG avidity. Because of concern for malignancy, the patient underwent laparoscopic resection of the mesenteric lesion, with intraoperative findings of lumpiness of the liver and mid- small bowel and creeping fat in the nearby small bowel. Pathology revealed benign fibroadipose and lymphoid tissues. At this point, double- balloon enteroscopy was attempted for capsule retrieval, which was unsuccessful due to tethering and fixation of the bowel. A CT Enterography revealed focal narrowing of distal jejunum/proximal ileum, submucosal edema, mucosal hyperenhancement with sparing of terminal ileum. Colorectal surgery was consulted, and intra-operatively found a forming fistula in the pelvis to the vaginal vault/bladder, and a 25 cm segment of small bowel with thickened mesentery and multiple strictures. Small intestine pathology was consistent with Crohn’s disease. Post-operatively the patient was started on Infliximab (5 mg/kg) induction and is now maintained on IFX.

Discussion: We present a case of penetrating ileal Crohn’s disease diagnosed after small bowel resection despite normal EGD and colonoscopy. This case highlights the need to evaluate small bowel Crohn’s disease with imaging in the setting of ongoing clinical symptoms and intraoperative findings, such as creeping fat, elevated stool calprotectin, and retained video capsule endoscopy.

Disclosures:
Daniel Conde indicated no relevant financial relationships.
Nathaniel Saffran indicated no relevant financial relationships.
Stephanie Socias indicated no relevant financial relationships.
Alexandra Gutierrez indicated no relevant financial relationships.

Daniel Conde, MD, Nathaniel Saffran, MD, Stephanie Socias, MD, Alexandra Gutierrez, MD. P3399 - Small Bowel Crohn's Disease Diagnosed on Exploratory Laparotomy, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.