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Daniel J. Stein Profile picture
Daniel J. Stein
@DSTEINGIMD
Medical Director of the Inflammatory Bowel Disease Program at Froedtert and the Medical College of WI dedicated to caring for Crohn's and Colitis patients
May 1, 2023 • 5 tweets • 16 min read
@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.