A 44-year-old male with no history of interest, diagnosed with ulcerative colitis and treated with total colectomy and terminal ileostomy due to toxic megacolon.
She came to the emergency room for diffuse colic abdominal pain of 18 hours duration, with several liquid stools initially, and intestinal closure in the last hours.
On examination, the abdomen was distended and painful, with absent breath sounds.
Right iliac terminal ileostomy with low output and non-reducible paraileostomal hernia.
Analytically, he had normal and biochemical blood count with glucose 388 mg/dl, urea 98 mg/dl, AST 50 U/l, ALT 52 U/l, LDH 556 U/l, CK TG 159 U/l
Venous gas, ionogram and coagulation were normal with fibrinogen of 891 mg/dl. Simple radiography and abdominal CT were compatible with intestinal occlusion.
abscesses due to lack of response to medical treatment, it was decided to surgically treat the paraileostomic hernia later presenting worsening of the general state, signs of sepsis and deep ostomates, skin and subcutaneous tissue around other cm
During the postoperative period, the patient begins with diffuse bleeding through the ileostomy orifice and necrosis in the last centimeters of it.
Upper endoscopy, up to the second duodenal portion, was normal.
Once these findings are established, the surgical wound is reopened, with necrosis of the last centimeters of the ileostomy loop, active bleeding from deep ulcerations of the mucosa and covered clots 50 cm.
Pathology of the specimen is compatible with Crohn's disease.
The patient continued with persistent gastrointestinal bleeding and signs of hemodynamic instability, requiring transfusion of 10 negative concentrates of thorax, performing abdominal procedures and 2 fibrinogen, with no response to full-dose corticotherapy, so he began treatment with an infectious plaque TAC.
Five days after the first dose of infliximab, bleeding subsides and three months later is asymptomatic, with maintenance therapy with infliximab and control enteroscopy, intestinal mucosa without ulceration is observed.
