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.
Subcutaneous adalimumab was started, with rapid symptoms response.