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