Case Report: Fistulising fellows - diverticular and Crohn’s disease

Abstract

A 62 year old female was diagnosed with Crohn’s colitis and complex perianal disease, in April 2010. Colonic involvement to the splenic flexure was confirmed on endoscopy and subsequent colonic biopsies demonstrated active non-necrotising granulomatous inflammation. Sigmoid diverticulosis was noted on the index endoscopy, in addition to the index contrasted abdominal computerized tomography scan (CT). A perianal fistula and peri-natal cleft ulceration was confirmed during examination under anaesthesia and a seton was inserted through the fistulous tract. The initial therapeutic regimen included systemic and topical corticosteroids, in addition to concurrent oral Azathioprine. However, both Azathioprine and then 6-
mercaptopruine, resulted in severe gastrointestinal side effects, necessitating a change to intramuscular Methotrexate at a dose of 25 mg weekly.1 This sequence of therapeutic setbacks resulted in poor overall control of the disease.