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CASE PRESENTATION
A 21-year-old male with history of Crohn’s disease presented to the emergency department with complaints of abdominal distention and right lower quadrant pain. He was initially diagnosed with Crohn’s disease seven years prior, and his disease was well-controlled on a regimen of Mesalamine (Asacol, ©Actavis Pharma). However, after switching to
an alternative formulation of Mesalamine (Pentasa, ©Shire
pathologically one month prior to his presentation. He was started on Prednisone and Adalimumab. In the three weeks leading to his presentation, his abdominal distention worsened and he began experiencing diffuse aching pain throughout
his abdomen with greater intensity on the right side. Upon presentation his vital signs included a blood pressure of 134/96, a pulse of 99, and temperature of 99.3 degrees Fahrenheit. Laboratory testing was notable for a leukocyte count of
13.3 (reference range: 3.5-10.5 10ˆ3/uL) with a left shift and bandemia. CRP was elevated at 16.2 (reference range <=0.5 mg/ dL). Cross sectional imaging of the abdomen with IV contrast (Figure 1) demonstrated a 34cm x 23cm x 11 cm rim-enhancing
FIGURE 1
Computed tomography of the abdomen and pelvis with IV contrast, horizontal (panel
A) and coronal (panel B) sections revealing a large rim-enhancing
fluid collection throughout the abdomen (asterisks in both panels) representing the intra-abdominal abscess.
large intra-abdominal abscess. He underwent an exploratory laparotomy, abdominal washout, and wound vacuum placement. citrobacter, veillonella and candida glabrata. A bowel perforation was suspected as the etiology for abscess formation; however magnetic resonance heterography (Figure 2) was unremarkable. He remained stable, tolerated a general diet for the remainder
of his hospital course, and was discharged with a two-week
with appropriate follow-up. His course was complicated with recurrence of intra-abdominal abscesses and a colocutaneous was later taken down and a colorectal anastomosis was performed with an uneventful postoperative course. He followed as an
DISCUSSION
It is felt that abscess formation in Crohn’s disease occurs secondary
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