Keywords
Crohn's Disease
Fistula
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Abstract
Objective: To report the case of a patient with a diagnosis delay of 15 years for Fibrostenosing-Fistulizing Crohn's Disease (CD), diagnosed at an advanced stage with an entero-sigmoid fistula, describing the clinical course and the interventions performed. Case detail: Male patient, 27 years old, smoker, with report of chronic abdominal pain associated with diarrhea since he was 14 years old. Laboratory tests showing evidence of inflammation and positive anti-Saccharomyces cerevisiae (ASCA) antibody. Colonoscopy showed alterations suggestive of active CD and enteroresonance showed regions of stenosis in the distal ileum and ileo-sigmoid fistula with indication of a surgical approach. The patient had CD refractory to corticosteroid therapy, requiring multiple optimizations and replacement of immunobiologicals from Infliximab (IFX) to Adalimumab (ADA), with resolution of the fistula at the expense of progression of stenosis in the terminal ileum, keeping patterns of exacerbation and remission of the disease. Final considerations: The 15-year diagnostic delay due to nonspecific symptoms, intermittent clinical course and loss of patient follow-up, in addition to smoking, were fundamental for the progression of the cronic inflammatory process and the development of a more aggressive profile of the disease.
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