CT scan reveals dilated fluid filled small bowel loops, with thickening and enhancement of the distal ileum and a transition point at the level of the terminal ileum, consistent with small bowel obstruction.
Serum CRP is 19mg/ L ( nml range 1-10mg/L )
The patient undergoes a trial of conservative management with NG decompression and bowel rest and IV steroids, with no improvement after 4 days. She decides to undergo surgery and 30 cm of distal ileum and her cecum and ascending colon are resected. Pathology reveals active inflammation in the distal ileum with caseating granulomas and transmural ulcerations.
You are called to see the patient again on day #6 post op
She was recovering well post surgery, however on post op day #5 she developed > 6 episodes of profuse watery diarrhea. She has no accompanying abdominal cramps, nausea, vomiting or fever
She is not on recent new medications.
Her labs are shown below. CT enterography shows no small bowel enhancement or thickening
CRP 5 mg/dl
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