A 54-year-old male was diagnosed in 1991 (at 35 years of age) with CD with a stenosing-phistulizing pattern.
During its evolution it has required multiple admissions for severe sprouts and different surgical complications of its disease.
The first years after diagnosis she received treatment with steroids and 5-ASA with good response.
In 1995 a descending colon stenosis was observed, which was not operated at that time.
In early 1999 she presented an abdominal wall abscess requiring surgical intervention.
At the end of this same year, an anal fibrous stenosis was diagnosed, which was dilated endoscopically and a double sigmoid stenosis. A new therapeutic approach was rejected.
He was re-admitted in May 2000 due to a new wall abscess that was intervened. A enterocutaneous fistula remained as a late complication, which also required surgical treatment months later.
At the end of 2001 the presence of patched inflammatory strictures at the level of terminal ileum and those already known of descending colon, one of them fistulized to the left lumbar region requiring segmental colorectal anastomosis with colon is shown.
In 2004, it was decided to start treatment with azathioprine, having to remove it up to two times and then suspend it definitively for presenting the patient several adverse effects with its administration, such as stiffness, lower limbs and loss of strength.
In 2007, hospital admission due to rectal bleeding with clinical and analytical repercussions returned.
On this occasion a severe perianal fistulizing affectation was observed, without affectation of the colorectal anastomosis along with the presence of inflammatory activity in the terminal ileum.
In February 2008, treatment with infliximab was started, receiving its first dose after 17 years of evolution of its CD.
Partial initial response is achieved with doses equal to or greater than the interval between doses.
Nevertheless, due to a clear clinical worsening, the patient required hospitalization at the end of April of the same year.
A rectal stricture was performed showing a large ulcer and a stenosis of the colorectal anastomosis.
The radiological study revealed stenosis in the terminal ileum and proximal dilatation of small bowel loops.
The patient was discharged with steroid treatment in descending order, table, antibiotic therapy and infliximab (5 mg/kg every 6 weeks).
It remains asymptomatic and has a good evolution for several months.
She required a new admission in early 2009 due to rectal bleeding and anal pain.
Endoscopically, an important rectal involvement is observed, with a large ulcer at this level and an almost complete stenosis at the transverse colon.
A thinned and small caliber terminal ileum without fistulae is observed in a barium intestinal transit.
Months later, at the beginning of June 2009, she again consulted for presenting a significant worsening of her perianal involvement for several weeks, with disabling pain and incontinence.
An exploration was performed under sedation because the pain prevents sedation in the affected area with normal mucosa, rectal mucosa severely affected, presence of multiple, irregular ulcerations and spontaneous bleeding and the loop of the endoscopic material.
At this time, multiple samples are taken for histological study and to rule out an overinfection or presence of cytomegalovirus.
The pathology ruled out infection, but adenocarcinoma was reported, moderately differentiated in all samples sent from rectum and anus.
An extension study was then carried out, resulting negative and confirming the confinement of the rectal disease and anus. Consequently, the patient was submitted to amputation and definitive surgery, but underwent surgery.
Four months later she was admitted for bilateral pulmonary and femoral thromboembolism that required placement of a temporary vena cava filter and anticoagulation with low molecular weight heparins with several episodes of rectal bleeding requiring anticoagulation withdrawal.
During the same admission there was ileal intestinal perforation that required emergency surgical resection, all with normal imaging tests and good subsequent evolution.
She was readmitted 15 days later due to fever, two space occupying lesions in the liver.
The study showed recurrence of adenocarcinoma of the rectum, stage IV and presence of metastases, liver, bone metastases, currently undergoing chemotherapy.
