930952 diagnosed in 1995 ileocecal or ileal resection '19 '90 '5 laparotomy and right hemicolectomy 19 99 adhesiolysis in 02/2008 anoscopy july '20 '20 '1 narrowed neoterminal anastomosis with mild nonspecific inflammation in the ic valve mri small bowel 20 21 september 2 fibrotic strictures of 3.5 and 2.5 cm length in the neo terminal proximal small bowel not dilated mri small bowel with contrast september 20 23 2 fibrotic strictures in the neo 2 neo terminal ileum 2.5 centimeters each anastamotic stricture causing pre stenotic dilatation of the small bowel most recent colonoscopy january 20 25 ulceration of the anastomosis and some larger based ulcerations of the neo terminal ileum rutgers I 2 b intervening mucosa normal unable to deep into neo ti due to angulation single ulcer seen opposite tattooed mesenteric border 5 cm distal to anastomosis no other evidence of crohn's seen histology neoterminal allele biopsies actively inflamed intestinal mucosa and ulcer slough no evidence of dysplasia or invasive neoplasia cmv negative anastomosis biopsies small intestinal mucosa showing active chronic inflammation no evidence of dysplasia or neoplasia no viral inclusions or cmv and then serial colonic biopsies times 6 mild crypt architectural distortion but no evidence of significant inflammation dysplasia or invasive neoplasia no granulomas or viral organisms laparotomy and adhesiolysis for crohn's january 20 24 she actually underwent in january 2024 a laparotomy and hesialysis ic resection and kano s anastomosis bindings at dense adhesions ileocolic knot of small bowel with adhesions short stricture at the anastomosis within the knot no other structures excellent length of small bowel length of small bowel remaining I'm doctor miller 1 of the gastroenterology registrars nice to talk to you how are you good I'm glad I was going on a bit late I was just having a read over everything to make I understood everything that had gone on so from my understanding it looks like you had an operation back in january of 20 24 yeah and how have you been since then mhmm right which tablets are you on to stop you going to the toilet loperamide yeah fine so you're going to the luer lot right ove overnight really just pour out of you yeah and that was before you started the loperamide and how many times overnight would that be once a week mhmm and then about how much would you open your bowels and know about it overnight was that would that happen as well in the same night or on other nights yeah fine okay so a couple and how about in the day mhmm and how many times do you open your bowels in the day how about before the loperamide how much is quite a lot 10 times more than that some days 20 times fine maybe 10 to 15 times fine but that's before the loperamide but the loperamide's made a little bit of difference but not I can't imagine it's transformative and is this all worse since your operation over the last year or so or not did the operation make it better mhmm right okay mhmm mhmm yeah yeah I saw mhmm back in the nineties a couple of them and then 1 in 02/2008 I understand yeah fine okay mhmm plan number 1 course of steroids number 2 mri small bowel number 3 discussion of ibd mdt number 4 signposting to iron inflammatory bowel disease nurses number 5 blood tests including inflammatory markers and nutritional assessment number 7 dietetic review the dgp I had the pleasure of speaking on the telephone to missus harvey in gastroenterology clinic today on behalf of doctor hayward <\n\n> Miss harvey has had terminal allele crohn's disease since the nineties and has had multiple operative managements for this including most recently in january 2024 when she underwent further ileocecal resection, adhesiolysis and reanastomosis full stop <\n\n> Unfortunately, since then she's had more watery loose stools with significant fecal urgency including overnight full stop unfortunately, she's even had some accidents with this watery stool full stop she will get up overnight to open her bowels most nights of the week and during the day might open her bowels 10 to 15 times passing loose watery stools with significant urgency full stop she started herself on loperamide to try and manage this and it's made a slight improvement but not transformative full stop <\n\n> In terms of her diet, she's been trying to go back to her normal diet however has been decreasing her fruit and veg fiber intake in order to try and slow down her bowel movements full stop stop <\n\n> In terms of her family history, her son has been diagnosed with crohn's disease full stop <\n\n> We discussed today that her recent colonoscopy in january demonstrated ulceration of her anastomosis and in the neo terminal ileum and biopsies from here have demonstrated activity in her crohn's disease full stop <\n\n> She's never been on any treatment in terms of medical treatment for her crohn's disease and we discussed this briefly today full stop she struggled with her inhexa injections following discharge for her from her ic resection so she's reluctant to explore injection or medicines but would consider tablets or infusions full stop <\n\n> She works in a restaurant kitchen and obviously opening her bowels this frequently is quite challenging for her full stop she decides not to eat in order to limit her bowel motions full stop diagnosis is continued activity in crohn's disease + or - element of bile acid malabsorption we discussed that it may be that activity in her disease is causing things it seems most likely and so it'll be sensible to investigate this further with an mri of her small bowel as well as start some treatment in the form of steroids following the mri scan full stop I'll discuss her case of the inflammatory bowel disease mdt and we can establish what the optimal treatment would be for her I've also asked her to see the dietitians and look forward to following her up again in 6 weeks' time with some results full stop yours sincerely