Chen Yiyi, Wang Fei, Xu Lingna, Ke Qinbing, Ji Shujuan, Mao Jie, Jia Xiya, Lai Chuanxi, Dai Sheng
Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, People's Republic of China.
Provincial Key Laboratory of Precise Diagnosis and Treatment of Abdominal Infection, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, People's Republic of China.
J Inflamm Res. 2024 Dec 16;17:11129-11135. doi: 10.2147/JIR.S500687. eCollection 2024.
Herein, we described a case of small bowel Crohn's disease with recurrent, unexplained fevers, pain in the right lower back, hip, and groin area over 20 months. The patient did not present any gastrointestinal symptoms and colonoscopy showed no abnormalities. Imaging revealed a liver abscess and multiple lesions with pneumatosis in the muscles of the right lower back region. Initially, disseminated infection was suspected and the antibiotics was administered without success. Subsequently, Magnetic resonance (MR) enterography suggested the possibility of a small bowel fistula which was confirmed during exploratory laparotomy. Inflammation was prominent in a 27-cm segment starting from 30-cm proximal to the ileocecal junction. The segment was resected and pathological examination confirmed Crohn's disease. Postoperatively, mesalazine was administered, but showed limited efficacy. After modifying the treatment plan to infliximab and azathioprine, the patient was symptom-free and no obvious inflammation was found in the colonoscopy reexamination.
在此，我们描述了一例小肠克罗恩病患者，该患者在20多个月的时间里反复出现不明原因的发热，右下腹、臀部和腹股沟区疼痛。患者未出现任何胃肠道症状，结肠镜检查未发现异常。影像学检查发现肝脓肿以及右下腹区域肌肉内多发含气病变。最初怀疑为播散性感染，使用抗生素治疗无效。随后，磁共振（MR）小肠造影提示存在小肠瘘的可能性，这在剖腹探查术中得到证实。从回盲部近端30 cm处开始的27 cm肠段炎症明显。该肠段被切除，病理检查确诊为克罗恩病。术后给予美沙拉嗪治疗，但疗效有限。在将治疗方案改为英夫利昔单抗和硫唑嘌呤后，患者症状消失，结肠镜复查未发现明显炎症。
