Christina Ha, MD, AGAF, presents a deep dive into an inflammatory bowel disease (IBD) case originating from the AGA Community forum and will host the Roundtable discussion this week on “Clinical Challenges in IBD: Ulcerative colitis and a fistula.”
- 32 year-old man presents with a three month history of progressive diarrhea (eight to 10 stools/24 hours) and rectal bleeding (> 50% BMs)
- Associated symptoms: mucus, urgency with close calls, nocturnal bowel movements (one to three times nightly), abdominal cramping and 15 pound weight loss
- Reports bilateral knee pain/swelling over the past six weeks, but no other extraintestinal manifestations
- Labs: Hb 10.6 g/dL, C-reactive protein 26 mg/dL, albumin 3.4 g/dL
- Fecal calprotectin > 2000 mcg/g (nl < 162.9 mcg/g)
- C. difficile toxin PCR negative, enteric pathogen PCR negative
- Remote history of anal fistula following an anal abscess, treated with I&D, then fistulotomy, no recurrence since then.
Dr. Ha shares insight into different iterations of the patient scenario and on diagnosis and management options. Watch her full case presentation and then join us at the Community Roundtable to discuss your experiences.
Have you encountered patients with apparent UC who develop perianal complications? How does this change your management?