Intest Res.  2014 Jan;12(1):74-77. 10.5217/ir.2014.12.1.74.

Successful Treatment of Postoperative Fistula with Infliximab in a Patient with Crohn's Disease

• Jeong SY
• Moon JS
• Park KJ
• Kim YS

• KMID: 2174342
• DOI: http://doi.org/10.5217/ir.2014.12.1.74

Abstract

Nearly 80% of patients with Crohn's disease (CD) require surgical treatment for complications or failure of medical management. We managed a 31-year-old man with CD who presented with a post-operative fistula. The patient had undergone surgery due to multiple strictures and a fistula. However, a new fistula developed that connected to the intraperitoneal abscess. Intravenous antibiotics were started and multiple percutaneous drainage tubes were inserted to treat the abdominal abscess. However, the amount of drainage was consistently high, even one month after the operation. To treat the postoperative fistula, 5 mg/kg of infliximab was started, and the amount of drainage decreased dramatically to less than 10 cc a day. Some studies have reported that infliximab decreases the recurrence of CD after surgery. The effect of infliximab on post-operative fistulas in patients with CD has not been sufficiently studied. Our results indicated that the use of infliximab to treat post-operative fistula should be explored further in future clinical studies.

Keyword

Crohn's disease; Fistula; Infliximab

MeSH Terms

Abdominal Abscess
Abscess
Adult
Anti-Bacterial Agents
Constriction, Pathologic
Crohn Disease*
Drainage
Fistula*
Humans
Infliximab
Recurrence
Anti-Bacterial Agents

Figure

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  Fig. 1 Small bowel series (A) and abdominal CT scan (B) findings. They revealed ileocolic fistulas (arrows), multiple small bowel stenosis, and dilated small bowel loops with abundant fecal material.

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  Fig. 2 Gross findings during surgery. Ileocecectomy, rectal repair (yellow square), and small bowel and sigmoid resection (black square) were performed.

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  Fig. 3 Postoperative abdominal CT scan. It showed a fistula (black arrows) and intraperitoneal abscess (white arrows), which needed percutaneous drainage (A: coronal view, B: axial view).

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  Fig. 4 The follow-up abdominal CT findings. The abscess and fistula disappeared (A: coronal view, B: axial veiw).

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