Case 12

Case Submitted by Shreya Patel, MD.

A 37-year-old man with a history of well-controlled HIV, prior appendectomy, and BRCA2 pathogenic mutation carrier presents for clinic follow-up. While living out of state in 2000, he reports being diagnosed with Crohn’s disease after surgical treatment for an anal fistula. He underwent an open appendectomy in 2001 for presumed ruptured appendicitis, though was told his appendix was normal. Since then, he has had multiple admissions for small bowel obstructions across the United States, typically treated conservatively, though he did undergo a laparoscopy in 2013 that was unremarkable by patient self-report. He has had multiple EGDs and colonoscopies over this time period that have all been normal. 

Since under your care, he underwent MR or CT enterographies in 2018, January 2020, and November 2020 that all continued to show multiple discrete segments of small bowel thickening and narrowing with hyperenhancement, the most severe in the terminal ileum with prestenotic proximal dilation. He subsequently underwent a repeat EGD/colonoscopy to the terminal ileum that was endoscopically and histologically normal. He has continued to report minimal to no symptoms in between obstructive episodes.