21 year Male underwent fistula surgery 3 months back came with pain abdomen and fever Ct abdomen done Diagnosis and Next course ?

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Young male with recurrent Fistula? Crohns disease Ileocolic disease is the most common type of GI involvement(50℅) Ileal involvement occurs in 30% I guess The pt has to be treated in a proper way.. Lifestyle and Dietary changes are very important... Corticosteroids can be tried for short period followed by replacement with immunosuppresives.... Anti TNF Alpha agents are in increasing use in refractory cases... Surgery is of no value because disease occurs in non involved segments...

Circumferential thickening of terminal ileum Clumping of bowel loops in right iliac fossa Fat stranding, partial instruction of ileum Mild dilatation of ileal loops Contrast seen passing into caecum, ascending colon Appendix not well visualised ADV Analysis of CT images on console ? Appendicitis ? Tuberculosis of intestine

Young male with recurrent Fistula Ileocolic disease is the most common type of GI involvement(50℅) Ileal involvement occurs in 30% I guess The pt has to be treated in a proper way.. Lifestyle and Dietary changes are very important... Corticosteroids can be tried for short period followed by replacement with immunosuppresives.... Anti TNF Alpha agents are in increasing use in refractory cases... Surgery is of no value because disease occurs in non involved segments...

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He has contained perforation with localised peritonitis Options of surgery explained Managed conservatively with nbm fluids antibiotics Improving clinically Recheck ct no leak noted Planning to start immunomodulators after 2 weeks of antibiotics

With the history of fistula surgery, pain abdomen,fever and clumping of bowel in right lower abdomen on CT scan, seems to be a case of inflammatory bowel disease -? Crohn's. Fistula in these cases is multiple, non healing with a high chance of recurrence, if disease not cured

Circumferential thinking of terminal ileum climbing of bowel loops in right iliac glass.

Chain's or tuberculosis If there is intestinal obstruction laparotomy Otherwise colonoscopy/DIAGNOSTIC laparoscopy

By Clinical rule out Appendicitis

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