Thread by @DSTEINGIMD

@MondayNightIBD @DCharabaty @abbvie @TakedaPharma @GKochharMD @GauravsyalMD @IBD_FloMD @SaraElOualiMD @BenClickMD @HolubarStefan @SchwartzbergMD @BettenworthDb @SchairerIBDMD @JPAchkarMD 32 w SB #Crohns x15yrs, ICR + jejunal✂️for sympt strictures 3 yrs ago. Presents w SBO, CT: jejunal🔥->IV steroids+ started IFX 10mg/kg.
4mos later: Wt loss, abdo pain, melena. Hgb 6,CRP nl, IFX 10. CT: SBO, jejunal thickening, ⬇️🔥. Not better on IV steroids x48hrs.
What's next?

@MondayNightIBD @DCharabaty @abbvie @TakedaPharma @GKochharMD @GauravsyalMD @IBD_FloMD @SaraElOualiMD @BenClickMD @HolubarStefan @SchwartzbergMD @BettenworthDb @SchairerIBDMD @JPAchkarMD Thread 1/4 NL CRP,⬇️🔥 on CT 🚫 response to IV steroids🟰fibrotic stricture. CT angiography neg.. Enteroscopy not attempted d/t dilated SB.  ALSO phenotype change: melena and weight loss raised 🚩🚩. So ✂️ and found to have jejunal adenoCA, 🚫nodes or metz.

@MondayNightIBD @DCharabaty @abbvie @TakedaPharma @GKochharMD @GauravsyalMD @IBD_FloMD @SaraElOualiMD @BenClickMD @HolubarStefan @SchwartzbergMD @BettenworthDb @SchairerIBDMD @JPAchkarMD Thread 2/4 Key points: Need to consider SB ACA in CD pt with change in phenotype. Crohn's about 10Xs gen pop for SB ACA.  RFs: ♂️, young age at Dx, long disease duration, multiple resections, diverted bowel, immunosuppressive use. All of which our patient had.

@MondayNightIBD @DCharabaty @abbvie @TakedaPharma @GKochharMD @GauravsyalMD @IBD_FloMD @SaraElOualiMD @BenClickMD @HolubarStefan @SchwartzbergMD @BettenworthDb @SchairerIBDMD @JPAchkarMD Thread 3/4 CTE/MRE may only be 11% sensitive in diagnosing SB ACA prior to surgery so don't be falsely reassured by those results. Again this case demonstrates that. link.springer.com/article/10.100…

@MondayNightIBD @DCharabaty @abbvie @TakedaPharma @GKochharMD @GauravsyalMD @IBD_FloMD @SaraElOualiMD @BenClickMD @HolubarStefan @SchwartzbergMD @BettenworthDb @SchairerIBDMD @JPAchkarMD Thread 4/4 BE wary of the change in phenotype If always diarrhea and now obstructed sx or long term in remission and now obstructed think malignancy especially in your patients with long duration of disease. Patient had ChemoTx and is cancer free two years out at this point. 🎉🙌