肛周脓肿及阑尾炎术后最终确诊小肠克罗恩病一例：从诊断延迟到生物制剂治疗获效

A Case of Crohn’s Disease of the Small Intestine Was Finally Confirmed after Perianal Abscess and Appendicitis: From Diagnosic Delay to Effective Treatment of Vidrizumab

摘要: 本文报告1例33岁男性，先后因肛周脓肿、化脓性阑尾炎行手术治疗，经3年后，因腹痛、腹泻、发热就诊，CT发现回盲部及小肠节段性肠壁增厚伴不完全性肠梗阻，首次住院拒绝肠镜检查，出院后症状加重，最终经肠镜及病理活检确诊为小肠克罗恩病。对于青壮年不明原因肛周脓肿、阑尾炎术后仍反复腹痛者，应早期筛查克罗恩病。即使肛周脓肿病理为非特异性改变，也不能完全排除克罗恩病的可能。诊断延迟可导致肠梗阻等并发症发生，维得利珠单抗治疗有效。

Abstract: A case of a 33-year-old male is reported in this study. He underwent surgical treatment for a perianal abscess and suppurative appendicitis. Three years later, he presented with abdominal pain, diarrhea, and fever. A CT scan revealed segmental thickening of the intestinal wall in the ileocecal region and the small intestine, accompanied by incomplete intestinal obstruction. During his initial hospitalization, he refused to undergo a colonoscopy. After discharge, his symptoms worsened, and he was eventually diagnosed with small bowel Crohn’s disease through colonoscopy and pathological biopsy. Early screening for Crohn’s disease is recommended for young to middle-aged adults who present with unexplained perianal abscesses or recurrent abdominal pain following appendectomy. Even if the histopathological analysis of a perianal abscess shows nonspecific changes, the possibility of Crohn’s disease should not be completely ruled out. A delayed diagnosis may lead to complications such as intestinal obstruction, and treatment with vedolizumab has been shown to be effective.