Case 5. Stricturing ileal Crohn’s disease



A 42-year-old patient with long-evolving stricturing ileal CD, with repeated subocclusive crises and predominantly fibrotic ileal stricture. Surgical resection of the affected portion was thus decided.

Three months after surgery the patient developed diffuse abdominal pain and diarrhea (6-8 depositions a day). The laboratory tests showed mild ferropenic anemia and increased C-reactive protein (30 mg/l).

Ileocolonoscopy was carried out. The patient presented a greatly angulated end-to-side anastomosis apparently without alterations or stricture, though this point could not be passed to correctly evaluate the ileal loop. The MRE study could not be completed due to patient claustrophobia; the small bowel was therefore evaluated by capsule endoscopy.


Figure 1 and Figure 1bis. Capsule images in two different ileal segments, both with important disease. Extensive affected neo-ileal segment (corresponding to 30% of the small bowel), with stellate and longitudinal ulcerations compatible with Rutgeerts score i4 recurrence.

Subcutaneous adalimumab was started, with rapid symptoms response.


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