The abscess is amenable to percutaneous drainage by radiology, which is performed. The patient is also started on IV antibiotics. Biologic therapy is deferred in the setting of active sepsis. After one week of IV antibiotics, the patient’s sepsis has resolved. Though he continues to have right lower quadrant abdominal pain and bloating, he is passing gas and diarrheal stools. He undergoes colonoscopy which demonstrates normal mucosa throughout the colon, and large, deep serpiginous ulcers involving over 30% of the mucosal surface with confluent surrounding erythema and edema, as well as an area of luminal narrowing 8 cm into the ileum that is unable to be passed, consistent with severely active ileal Crohn’s disease. Follow-up CT scan shows complete drainage of the abscess. He is evaluated by colorectal surgery and is taken to the operating room for resection of the involved segment of ileum with primary anastomosis.
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