A 37-year-old man comes to the physician 12 hours after the onset of vomiting and abdominal cramps and swelling. He has had constipation for the past 4 days. He was diagnosed with Crohn disease 7 years ago. His symptoms of diarrhea and right lower quadrant abdominal pain have been well controlled with mesalamine for the past 3 years. His temperature is 36°C (96.8°F), pulse is 98/min and regular, and blood pressure is 110/70 mm Hg. Examination shows a diffusely distended, tympanitic abdomen and visible peristalsis; high-pitched bowel sounds are heard. Rectal examination shows no stool in the rectal vault. An x-ray of the abdomen shows a small-bowel obstruction. Which of the following is the most likely cause of these findings?
) Colon cancer
) Ileocecal fistula
) Small-bowel adhesions
) Small-bowel fibrotic stricture
) Small-bowel intussusception
The answer is "C", the reason is b/c the granulomas tend to adhere to adjacent structures which it could be another bowel loop of even the abdominal wall, this will cause SBO for now and fistula later. This is why if the have granulomas evident by obstruction or fistula (if too late)is to put them on an alfa-TNF inhibitor (abciximab or others). TNF is the factor that granulomas need to keep strong and continue building new ones, but when inhibited these granulomas will start to degenerate and break down.
This is why you need a PPD skin test for dormant or latent TB prior to starting this drug on your patient b/c you can release the TB once the granuloma is degenerated and you can have your patient with another problem on top of his Crohn and that is active TB.
The answer for sure is not C. I got this question wrong and my answer was C.
Answer is "D" Its the same principle behind why Crohns disease has a characteristic 'string sign' on radiology