We report the case of a 77-year-old man with a 12-year history of CD of the distal ileum, an inflammatory phenotype, who was treated with a 3 g patch per day and budesonide 9 mg per day.
No prior use of radiation therapy or biological therapy
She presented with three days of abdominal pain in the left flank and periumbilical region associated with nausea and vomiting.
She reported no diarrhea, rectal bleeding or fever.
Examinations showed mild leukocytosis, and CT scan of the abdomen and pelvis (CT-PA) concluding segmental parietal thickening of the distal segment of the parietal pleura with an inflammatory appearance, with no evidence of chronic flaccid ischemia, two cm.
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She was hospitalized in the Intermediate Care Unit and started antibiotic treatment with ceftriaxone-Metronidazole.
Twenty-four hours after admission, the patient presented clinical and laboratory deterioration.
The TC-AP was repeated confirming a progression of inflammatory involvement at the diverticular level of the cyst and without complications (free perforation, ischemia or inflammatory changes at the level of the ileum).
Severe and severe sepsis, in multiorgan septic shock (MO) requiring support from active drugs, antibiotic modification to vancomycin, openem and severe mechanical anidula hemodialysis and severe mechanical ventilation failure.
Management with gastroenterology and coloproctology instability is discussed, given the severity and severity of the patient undergoing surgery while maintaining inadequate support.
It slowly withdraws the support of vasoactive drugs, mechanical ventilation and hemodialysis with progressive reinitiation of enteral feeding.
On the tenth day, an AP-CT scan showed an enlarged collection in the left flank mesentery, without inflammatory diverticular activity or distal ileum.
On the 11th day piperacillin/tazodone was started and anhydrulate, meropenem and vancomycin (adjusted with blood culture results) were suspended.
On day 20, an AP-CT showed a significant decrease in the size of the collection and jejunal diverticula, measuring the largest 3.2 cm compared to 4.3 cm in the previous examination.
At day 28, the images show only a small residual collection of 13 x 21 mm. After 28 days of intravenous antibiotic therapy, the patient is discharged with indication of moxifloxacin 400 mg/day oral therapy for 14 days.
Two months after discharge and being asymptomatic, a control with non-observable images or CE activity was performed.
