Concluded Case

Case of enterocutaneous fistula

34/F intially symptomatic in 2016 with RHC pain and significant weight loss for which she was diagnosed outside with ileal stricture ? tubercular etiology and was given ATT x 9 m f/b Prednisolone x 6 m I/v/o incomplete symptom resolution. She was asymptomatic for 3 years. Again since Jan 2020 having similar symptoms, with development of swelling in right lumbar area in June 2020, underwent CT s/o retroperitoneal collection of 15 cm which was drained surgically with placement of drain. Patient was started on ATT and then was referred to us. Patient underwent colonoscopy s/o ileal stricture with colocolic fistula. Gradually patient improved with reduction in drain output and weight gain. But biopsy was s/o CD for which patient was started on Prednisone and Azathioprine in mid-August 2020. Chief Complaints Presently patient c/o feculent discharge in drain since 12 days Investigations Present CT scan is attached Management What should be the further management? Biologicals or biologicals and then surgery?

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Concluded answer

A repeat CT scan was obtained which showed on residual collection. Culture of the drain output yielded E. coli sensitive to Piperacillin + Tazobactam. Patient was planned for Infliximab induction followed by surgical resection (right hemicolectomy + ileotransverse anastomosis) and then to continue biological to prevent recurrence as the patient is at high risk for recurrence.

All Answers

A repeat CT scan was obtained which showed on residual collection. Culture of the drain output yielded E. coli sensitive to Piperacillin + Tazobactam. Patient was planned for Infliximab induction followed by surgical resection (right hemicolectomy + ileotransverse anastomosis) and then to continue biological to prevent recurrence as the patient is at high risk for recurrence.

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