In: Crohn's disease19 Aug 2012
Repeat investigations revealed recurrent Crohn’s disease of the terminal ileum, as demonstrated by a colonoscopy. Despite treatment with corticosteroids and azathioprine 100 mg/day over the next year, the bleeding, anemia and weight loss persisted. Another surgical procedure was therefore carried out in 1996, where a further 10 cm of the terminal ileum was resected.
At this time he was started on methotrexate 25 mg intramuscularly per week for 12 weeks; however, no improvement was noted. He was also being treated at this time with corticosteroids and azathioprine 100 mg/day. His problem persisted and he was seen again in 1998 where repeat colonoscopy revealed terminal ileal ulcers and surgery was once again considered.
Crohn’s disease was again demonstrated by histological studies of the resected segment. In 1997 he was seen once again for persistent bleeding and anemia. Colonoscopy once again demonstrated terminal ileal ulcers, which were consistent with Crohn’s disease on biopsy (Figure 1). The colon was normal.
Figure 1) Colonoscopic demonstration of ileal ulcers, June 1998
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