LAUSR

A 33-year-old female with a history of penetrating ileal Crohn’s disease (CD) complicated by ileal stricture and ileo-sigmoid fistula status post-ileocolic resection and segmental colectomy 10 years prior was seen for a complaint of abdominal discomfort and lower extremity edema. The patient was initially diagnosed with CD at age of 14. She was maintained on medical therapy with mesalamine followed by 6-mercaptopurine (6-MP) for several years. She developed a flare for which she was briefly treated with infliximab. Unfortunately, since she had stricturing disease prior to starting infliximab, she ultimately required ileocecal resection with primary ileocolonic anastomosis. After surgery, she was maintained with 6-MP, doing well for approximately 4 years. She later developed recurrent symptoms; colonoscopy showed moderate recurrence at the anastomosis with a stricture that was successfully dilated endoscopically. Adalimumab (ADA) was subsequently started in addition to the 6-MP, which induced clinical remission. A surveillance colonoscopy while receiving ADA showed small ulcerations limited to the anastomosis but was otherwise normal without evidence of recurrent disease. 6-MP was withdrawn, after which she was maintained on monotherapy with ADA. Clinical Course