Case report:
A 33-year-old man presented to the emergency department with an acute mechanical bowel obstruction. He reports also burning micturition. The patient had a past medical history of fistulizing and stenosing Crohn’s disease with anoperineal manifestations which was untreated. He has not consulted for 5 years. He smokes 10 pack-year and consumes cannabis occasionally. On examination, there was no fever. Vital signs were stable. The abdomen was distended and tympanic. The anal examination shows 7 productive fistulous orifices. The white blood cells count was 10100 per microliter. The hemoglobin level was 12 g/dL and the C-reactive protein was 78 mg/L. An abdomen radiography without preparation was performed showing gas-fluid levels. A computerized tomography scan of abdomen with IV contrast showed a CT appearance of chronic inflammatory bowel complicated by ileo-ileal, ileo-vesical and multiple perineal fistulas without intra-abdominal or parietal collection. It was also noted a duplication of the inferior vena cava with a left vena cava drained in the homolateral renal vein (Figure 1 and 2). The patient was scheduled for surgery (ileo-coecal resection, disconnection of the ileovesical fistula and placement of setons). Post operative outcome was favorable especially no hemorrhagic complications occured. An anti-TNF therapy after surgery was also scheduled due to perineal fistula.