Primum non nocere

Abstract

Purpose: 47 year old woman with a 5 year history of Crohn's disease was admitted to the hospital with a one day history of severe colicky periumbilical abdominal pain radiating to the back. Her Crohn's disease was in remission on Pentasa®, and previous Crohn's flares had typically involved less severe pain and more frequent bowel movements. CT scan of the abdomen was reported as partial small bowel obstruction and the patient was admitted to the hospital for parenteral steroids for presumptive Crohn's flare. Gastroenterology consult was obtained on Day 2 after the patient failed to improve on standard therapy. On further questioning the patient revealed that her symptoms began with chest pain following ingestion of a pork rib one day prior to admission. This pain initially resolved and the patient forgot the episode, but then came to the hospital after her abdominal pain began. Re-examination of the abdominal CT revealed a piece of bone in the distal small bowel (Figure 1). Recommendation was made to discontinue steroid treatment, continue supportive care and reevaluate with abdominal CT in 3 days. Follow up CT scan revealed the bone had passed to the cecum (Figure 2). Conclusion: Careful history taking and evaluation of imaging studies can help in avoiding unnecessary use of parenteral steroids in management of some typical flares of Crohn's disease.Figure