S3618 Delayed Diagnosis of Severe Crohn’s Disease Due to the COVID-19 Pandemic

Abstract

Introduction: Diagnostic IBD practice has been affected by COVID-19, with >50% of new diagnoses not having endoscopy in a UK nationwide study.1 A case series of delayed presentation of surgical complications related to IBD has been reported in Italy.2 We report a case of delayed diagnosis of severe Crohn’s disease due to the pandemic. Case Description/Methods: 57 year old woman was seen for chronic diarrhea of two months duration in January 2020. Her past medical history is noted for type 2 diabetes. Patient reported four-six liquid bowel movements daily associated with severe abdominal pain in the lower abdomen unaffected by eating. Infectious evaluation was negative. A CT Abdomen without contrast in January 2020 showed terminal ileitis with a hazy infiltration of the fat and thickened small bowel loops suggestive of enteritis. Her fecal calprotectin and CRP were both elevated at 846 ug/g and 4.2 mg/dl, respectively. Patient was planned and scheduled for colonoscopy with random biopsies and terminal ileum intubation and small bowel capsule endoscopy. The planned procedures were deferred due to the pandemic as endoscopy services were not available at our institution between March 2020-July 2020. Patient was lost to follow-up until December 2020; patient expressed fear of receiving care amidst the pandemic. Colonoscopy in March 2021 was unremarkable endoscopically and histologically with difficulty in intubating the terminal ileum due to anatomy. Small bowel capsule endoscopy in March 2021 showed several aphthous ulcers and significant enteritis with diffuse ulcerations in the small bowel (Figure 1A-C). The findings are highly suggestive of Crohn’s disease. Patient underwent CT Enterography in May 2021 that showed mucosal edema with wall thickening of the terminal ileum (Figure 1D). Patient is planned for biologic therapy for suspected small bowel Crohn’s disease. Discussion: Our case report describes a case of delayed diagnosis of Crohn’s disease due to unavailability of endoscopy services and patient-related factor of fear of the pandemic. Future studies should evaluate for any diagnostic delay in IBD care in the United States.Figure 1.: A-C: Small bowel capsule endoscopy showing aphthous ulcers and significant enteritis with diffuse ulcerations in the small bowel. Figure 1D: CT Enterography showing mucosal edema with wall thickening of the terminal ileum.