Crohn’s disease. Colonic location

INFLAMMATORY COLIC STRICTURE
TREATMENT WITH ADALIMUMAB

A 59-year-old female smoker diagnosed with ileocolic CD four years ago. The patient was stable under maintenance treatment with azathioprine. Clinically, she experienced only mild, self-limiting episodes of abdominal pain. The control laboratory tests showed sustained C-reactive protein elevation (20 mg/l). Colonoscopy was thus decided.

Figure 1. Normal mucosa up to the distal transverse colon, where stricturing not passable by the endoscope was observed. Nodular lesions were seen, with a cobblestone pattern. Superficial ulcers were observed adjacent to the stricture, with transmural thickening and en bloc sweeping of the entire zone upon obtaining biopsies.

The histological findings of the samples obtained indicated Crohn's disease with acute and chronic inflammatory changes. MRE revealed a stricture of inflammatory appearance, with high degree of activity. In agreement with the patient, treatment was started with adalimumab, followed by disappearance of the symptoms and normalization of the laboratory test parameters. Endoscopic control was performed after 6 months of treatment.

Figure 2. Reduction of the degree of stenosis in the zone, allowing passage and reaching the cecum without difficulty. Upon withdrawal from the cecum, and on reaching the affected zone, nodular lesions were still noted, though these were now fewer in number and with lesser thickening, and a reduction of the degree of stenosis and of the transmural inflammatory component was observed.