case_images: PMC11789204_01
case_images: Results of physical examination. (A) The patient presented with a small ulcer at the 3 o'clock position and a large ulcer at the 9 o'clock position of the anus. (B) PEN therapy led to an improvement in clinical symptoms.. PEN: partial enteral nutrition
case_images: cureus-0017-00000076898-i01.jpg
case_images: PMC11789204_01_cureus-0017-00000076898-i01.jpg
case_images: FIG1
case_images: A large ulcer was noted at the 9 o'clock position (Figure 1A). PEN therapy, including an elemental diet of 300 kcal/day and a fat-restricted diet, improved the clinical symptoms of anal fistulas (Figure 1B).
case_images: Results of MRI. Short T1 inversion recovery MRI of the buttocks showing complex anal fistulas and a perianal abscess (yellow arrowhead): (A) Sagittal view. (B) Coronal view.
case_images: cureus-0017-00000076898-i02.jpg
case_images: PMC11789204_01_cureus-0017-00000076898-i02.jpg
case_images: FIG2
case_images: Esophagogastroduodenoscopy results. Esophagogastroduodenoscopy of (A) the esophagus, (B) the stomach, and (C) the duodenum revealed no abnormal findings.
case_images: cureus-0017-00000076898-i03.jpg
case_images: PMC11789204_01_cureus-0017-00000076898-i03.jpg
case_images: FIG3
case_images: Esophagogastroduodenoscopy and colonoscopy revealed no abnormalities (Figure 3, Figure 4).
case_images: Colonoscopy results. Colonoscopy revealed no abnormal findings in (A) the terminal ileum, (B) the cecum, (C) the ascending colon, (D) the transverse colon, (E) the descending colon, (F) the sigmoid colon, (G) the rectum, or (H) the anus.
case_images: cureus-0017-00000076898-i04.jpg
case_images: PMC11789204_01_cureus-0017-00000076898-i04.jpg
case_images: FIG4
case_images: Esophagogastroduodenoscopy and colonoscopy revealed no abnormalities (Figure 3, Figure 4).
case_images: Histopathological examination results. Histopathological examination revealed noncaseating epithelioid cell granulomas (arrowhead) in the terminal ileum. Original magnification: x400.
case_images: cureus-0017-00000076898-i05.jpg
case_images: PMC11789204_01_cureus-0017-00000076898-i05.jpg
case_images: FIG5