Case Report
Rethinking Intra-operative Management of Crohn’s Disease: Intestinal Ultrasound Detects Microscopic Disease Unidentified at Ileal Margin Resection
Issue:
Volume 9, Issue 2, December 2025
Pages:
90-93
Received:
4 June 2025
Accepted:
18 June 2025
Published:
23 July 2025
DOI:
10.11648/j.ijg.20250902.11
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Abstract: Crohn’s disease is a chronic and relapsing inflammatory condition that often requires surgical intervention. Post-operative recurrence of Crohn’s disease remains common after surgery occurring in up to 75% of patients. The role of disease-free surgical margins in post-operative recurrence has been debated, however, it has been identified as an independent risk factor for recurrence. We present a case of a woman with obstructive Crohn’s disease who underwent ileocecectomy and was maintained on uninterrupted infliximab therapy. Despite operative and pathology reports describing grossly normal surgical margins, three months post-operation the patient was experiencing new intermittent lower abdominal pain and intestinal ultrasound revealed active ileitis involving a 10cm segment immediately proximal to the ileocolonic anastomosis. Due to concern of incomplete resection, microscopic re-evaluation of the margins was conducted and confirmed histologically positive margins of active Crohn’s disease. Current guidelines have called for additional studies to examine the role of disease-free margins. Our case demonstrates the limitations of gross evaluation of disease-free margins and suggests a potential application of intestinal ultrasound intraoperatively for such assessment. While intestinal ultrasound has been utilized intraoperatively for colonic malignant margin identification, it has not yet been studied in inflammatory bowel disease and requires further evaluation.
Abstract: Crohn’s disease is a chronic and relapsing inflammatory condition that often requires surgical intervention. Post-operative recurrence of Crohn’s disease remains common after surgery occurring in up to 75% of patients. The role of disease-free surgical margins in post-operative recurrence has been debated, however, it has been identified as an inde...
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Charlotte Mary Duty
