Abdominal pain and fistula (209/1700)

A 79 yo lady who is otherwise well recently started abdominal pain. She is afebrile and
complains that she passed air bubbles during urination. A urethral catheter showed fecal
leakage in the urinary bag. What is the likely pathology?
a. Diuretics
b. CD
c. Rectosigmoid tumor
d. Large bowel perforation
e. UC


























answer: B

Crohns

Epidemiology:  bimodal: onset before 30 yr, second smaller peak age 60; M=F

C/P:

• most common location: ileum + ascending colon

• natural history unpredictable; young age, perianal disease, and need for corticosteroids have been associated with poor prognosis, but associations are not strong enough to guide clinical decisions

• most often presents as recurrent episodes of abdominal cramps, diarrhea, and weight loss

• ileitis may present with post-prandial pain, vomiting, RLQ mass; mimics acute appendicitis

• extra-intestinal manifestations are more common with colonic involvement

• fistulae, fissures, abscesses are common

• deep fissures with risk of perforation into contiguous viscera (leads to fistulae and abscesses)

• enteric fistulae may communicate with skin, bladder, vagina, and other parts of bowel