Interesting patient with Indeterminate Inflammatory Bowel Disease that I am uncertain how to approach:
23y/o wf with dx of IBD, initially thought to be Crohns. With birth of first daughter (and prior to birth) had problems with perianal fistulas, severe diarrhea, abd pain and cramping, and the birth complicated this (treated by out of town surgeon).
Sx’s were controlled well on medical management, but steroids not tolerated…a lot of side effects, and she was sent to me after workup revealed only colitis. Pt desired ileostomy and subtotal colectomy so she could be off of medications and have a second child (against many md’s advice). She had extensive education preop about ileostomy.
Colectomy specimen revealed findings more consistent with ulcerative colitis, so i had the specimen sent to a tertiary center close to Gail for review. A few “microgranulomas” were found, but they called it “indeterminate colitis”, a term which is new to me.
There was no small bowel disease that i could grossly see, and the pancolonic disease was quite severe. The perianal disease seemed more like crohns. It has all since healed.
She is quite unhappy about her ileostomy and has never adjusted well and has been nagging me to take it down (it was a long hartmans and wouldn’t be too hard of an operation), but obviously if this is UC i ought to send her to a center for evaluation for a pouch proceedure (which I don’t do). Her ileostomy functions very well, and is one of the best i have done.
With the birth of her second child, interestingly enuf, the baby has had significant bowel problems (bloody diarrhea) and upon evaluation was also diagnosed with colitis.