Palabras clave
Enfermedad de Crohn
Fístula
Cómo citar
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Resumen
Objetivo: Presentar el caso de un paciente con un retraso diagnóstico de 15 años por Enfermedad de Crohn (EC) Fibroestenosante-Fistulante, diagnosticado en un estadio avanzado de fístula entero-sigmoidea, describiendo la evolución clínica y las intervenciones realizadas. Detalle del Caso: Paciente masculino, 27 años, fumador, con reporte de dolor abdominal crónico asociado a diarrea desde los 14 años. Pruebas de laboratorio que muestran niveles elevados de inflamación y anticuerpos anti-Saccharomyces cerevisiae (ASCA) positivos. Colonoscopia sugestiva de EC activa y enterorresonancia con regiones de estenosis en íleon distal y fístula íleo-sigmoidea con indicación de abordaje quirúrgico. El paciente presentaba EC refractaria al tratamiento con corticoides, requiriendo múltiples optimizaciones terapéuticas y cambio del inmunobiológico de Infliximab (IFX) a Adalimumab (ADA) por desarrollo de inmunorresistencia a IFX, con resolución de la cicatrización de la fístula a expensas de agrandar las áreas de estenosis, mantener los patrones de exacerbación y remisión de la enfermedad. Consideraciones finales: El retraso diagnóstico de 15 años por síntomas inespecíficos, curso clínico intermitente y pérdida de seguimiento del paciente, además del tabaquismo, fueron fundamentales para la progresión del proceso inflamatorio crónico y el desarrollo de un perfil más agresivo de la enfermedad.
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