The conservative therapy of multiple colonic stenoses in a young patient with Crohn's disease

Introduction: The stenosis of the colon has benign forms like postsurgical, postirradiation, IBD caused strictures or malignant forms. The treatment of the stricture is determined by its severity and origin. Therapy includes dilatation, stent implantation or operation. We report on the ballon dilatation of multiple colonic stenoses in a Crohn's disease patient.

Patient and therapy: The 24 years old patient with the history of ulcerative colitis known since 2000, treated with mesalazine, budesonide and azathioprin was admitted to our department because of rectum stenosis, which manifestated after perianal abscess operation. In 2005 X-ray controlled gradual rectum balloon dilatatation had been performed two times. The patient's obstipation had been resolved, but because of the grade of the stricture total colonoscopy could not be accomplished. In 2006 after rectum dilatations, colonoscopy was carried out. Three more colonic stenoses were realized, and step by step ballon dilatation was performed in one session. No complication developed. On the basis of multiple strictures, and perianal abscess the possibility of Crohn's disease emerged and was proved by histology.

Conclusion: The progressive strictures as complication of active Crohn's disease are usually treated by operation. The bowel inflammation and the steroid therapy increase the complication rate of the operation. We emphasize that balloon dilatation contributes to the right diagnosis and therapy, helps postponing or avoiding surgical intervention and hereby plays a part in the improvement of the quality of the patient's life.