A 17-year-old female presented with unexplained symptoms not responsive to her existing IBD therapy (for known colitis and ileitis). She had initially developed diarrhea, abdominal pain, fatigue, weight loss, and anemia 5 years prior to presentation. Colonoscopy at that time revealed active colitis in the cecum and hepatic flexure. Small bowel follow-through (SBFT) showed narrowing of the terminal ileum. She was placed on 6-MP with prednisone as a bridge until the 6-MP could take effect.
A year prior to her current presentation, she had an ileocolonic resection for a 15 cm terminal ileal stricture, and stricturoplasty for 3 small strictures in mid-jejunum. There was no evidence of disease in the remainder of the small bowel at surgery. Post-op she was placed on 6-MP—however, the patient continued to have left lower quadrant pain and fatigue. Several months after surgery, esophagogastroduodenoscopy (EGD) was normal and colonoscopy showed a normal appearing colon but moderate inflammation in the ileum on biopsy. Her condition remained relatively stable; occasional mild disease flares were treated with metronidazole and hyoscamine.