Chiba Mitsuro, Tanaka Yuichi, Ono Iwao
Akita City Hospital, Division of Gastroenterology. Akita City, Japan.
Nakadori General Hospital, Division of Surgery. Akita City, Japan.
Autops Case Rep. 2019 Jan 14;9(1):e2018068. doi: 10.4322/acr.2018.068. eCollection 2019 Jan-Mar.
There is scarce knowledge on early intestinal obstruction in Crohn's disease (CD) after infliximab treatment. Therefore, we describe two cases of early intestinal obstruction in a series of 46 CD patients treated with infliximab. Both our two cases were 21-year-old men with newly diagnosed CD who were diagnosed with perianal disease 2 years previously. They were suffering from diarrhea and abdominal pain, but there were no symptoms indicating bowel obstruction. Radiographic studies revealed stenotic sites in the terminal ileum in both cases. In both cases, infliximab 300 mg was infused, after which their abnormal laboratory data as well as symptoms such as diarrhea and abdominal pain clearly improved. However, on the 11th or 13th day post-treatment, they presented abdominal distension with air-fluid levels on imaging studies. Ileocolonic resection was performed in both cases. Early intestinal obstruction after infliximab therapy is characterized by initial improvement of the symptoms and the laboratory data, which is soon followed by clinical deterioration. This outcome indicates that infliximab is so swiftly effective that the healing process tapers the stenotic site, resulting in bowel obstruction. Thus, although unpleasant and severe, the obstruction cannot be considered as a side effect but rather a consequence of infliximab's efficacy. CD patients with intestinal stricture, particularly the penetrating type with stricture, should be well informed about the risk of developing intestinal obstruction after infliximab therapy and the eventual need for surgical intervention.
关于英夫利昔单抗治疗后克罗恩病（CD）早期肠梗阻的知识尚少。因此，我们在一组接受英夫利昔单抗治疗的46例CD患者中描述了2例早期肠梗阻病例。我们的这2例患者均为21岁男性，新诊断为CD，2年前被诊断患有肛周疾病。他们患有腹泻和腹痛，但没有肠梗阻的症状。影像学研究显示，两例患者的回肠末端均有狭窄部位。在两例患者中均输注了300mg英夫利昔单抗，之后他们异常的实验室数据以及腹泻和腹痛等症状明显改善。然而，在治疗后的第11天或第13天，他们出现腹胀，影像学检查显示有气液平面。两例患者均接受了回结肠切除术。英夫利昔单抗治疗后的早期肠梗阻的特点是症状和实验室数据最初有所改善，但随后很快出现临床恶化。这一结果表明，英夫利昔单抗起效非常迅速，以至于愈合过程使狭窄部位变窄，从而导致肠梗阻。因此，尽管肠梗阻令人不快且严重，但不能将其视为副作用，而应看作是英夫利昔单抗疗效的结果。患有肠道狭窄的CD患者，尤其是伴有狭窄的穿透型患者，应充分了解英夫利昔单抗治疗后发生肠梗阻的风险以及最终进行手术干预的必要性。
