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Colorectal Diseases

Colonoscopy results

04/28/2008

Question:

A colonoscopy and SBFT for Crohn`s: Granulomas in the rectum and descending colon. The descending colon is severely diseased with acute and chronic inflammation and the bowel wall shows thickening and is narrowed. Sigmoid and rectum are diseased t a lesser degree. "Architectural distortion" in the rectum.

Two previous bowel resections 22 years and 12 years ago (removed 1 foot and then another 14 inches at terminal ileum) and now they say I have short bowel syndrome with estimated loss at 40%-50%???

Currently have three perianal fistulas with Setons in place. Taking no medications at this time. Tried Imuran in December and January and developed a fever and chills. Levels showed it was not working. Also have iron-deficient anemia.

1. What does "architectural distortion" mean?

2. Should I try Remicade or Humira and will either reverse the narrowed descending colon and close the fistulas for good?

3. What are the chances I will need another resection for Crohn`s that`s now in the descending colon if I try Remicade or Humira?

Thank you for your help.

Answer:

Architectural distortion is a term used by pathologists to describe changes consistent with chronic scarring, or changes in how the cells look under the microscope.

Remicade and Humira have been shown in some studies to help heal fistulas due to Crohn's disease in the anal region; your gastroenterologist should be able to help you sort out if you can have these immunomodulating drugs. They may also have a positive impact on your colonic inflammation.

Surgical resection in Crohn's disease is reserved for complications (stricture, bleeding, fistulas, etc) that do not respond to medical therapy.

For more information:

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati