Age: 45 Gender: male
A 45-year-old male with Crohn's disease was in need of a surgical resection of his colon due to significant damage from the disease. A surgical resection is simply a procedure to remove part of the intestine that is blocked or diseased. The surgery was successfully performed. Physician visit 1: On his first physician visit following the resection surgery (day 2), the patient was experiencing some pain but this was eased with pain medication. He was able to drink clear fluids and a plan was made to start him on solid food the next day along with the antibiotic metronidazole (Flagyl) to reduce the risk of Crohn's returning after surgery. The patient was prescribed azathioprine at his discharge from the hospital, which he had been on previously for three years. Azathioprine works by decreasing the activity of the body's immune system and is known to help those with Crohn's disease. He was also encouraged to become involved in a smoking cessation group. Physician visit 2: At the patient's second physician visit (six months after surgery) a colonoscopy was performed to view the condition of the resectioned intestine. Though the patient was feeling well, inflammation and many small ulcers were detected at the site of the resectioning. This indicates that the therapy is not working. A special blood test called 6-TGN is ordered to determine if azathioprine is properly dosed. Test results indicate that 6-TGN is low and a decision was made to increase the dose of azathioprine. Physician visit 3: At the third physician visit (four months after visit 2), another colonoscopy was performed and the bowel was healing nicely and the previous ulcers had disappeared. Case lesson: Patients who require surgery for Crohn's disease are at particularly high risk for significant long-term problems. Because of this risk, it is critical that inflammation be closely monitored and controlled following surgery through timely blood testing and colonoscopy checks.