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.