Biopsy Crohn's Disease

					Transrectal Ultrasound Guided
Prostate Biopsy in IBD/Crohn’s
        Disease case
     Carrie Fitzgerald Uro-1
        MM September
           2008 GCH
51 yo AA male seen in office
PSA 3.6 (velocity .82)
Family history positive for CaP
DRE not preformed secondary to anal
stricture
PMHx: Crohn’s disease
SocHx: smoker, ETOH use
ROS:
– Crohn’s diagnosed age 37; intermittant diarrhea,
  intermittant RLQ abd pain, bloating, tenesmus,
  without nausea or vomiting
– No history of anorectal fistulas or abscesses
– No h/o eneterenteric or enterovesicular or
  enterocutaneous fistulas
PE:
– No anal fissures, fistulas, hemmorrhoids
– Anorectal stricture ~16 Fr
Medication
– Sulfasalazine
– Prednisone taper 3 months prior
Transrectal ultrasound guided prostate
biopsy scheduled for OR
Pt IV sedation
Stricture digitalized by general surgery
DRE completed
Limited transrectal ultrasound guided
prostate biopsy (6 cores)
 Literature search
Keywords: prostate biopsy and CD/IBD,
 perineal biopsy and CD/IBD, strictures and
 CD/IBD, biopsy and CD/IBD, prostate
 cancer and CD/IBD
 PubMed
 Medline
 Ebsco
 FirstSearch
 A technique of transrectal ultrasound
 guided transperineal random prostate
 biopsy in patients with Ulcerative colitis
 and an ileal pouch.
Fergany, A and Angermeier, KW. Journal
 of Urology Jul 164 (1): 205-6.
Research questions
– Risk of fistula (UC/Crohns)
– Risk increase in active disease, with corticosteroids,
  in chronic disease, with fissures, previous fistulas,
  strictures
– Perineal biopsy a viable option
– Should patient have a prebiopsy sigmoidoscopy,
  evaluation
– Are there any external clinical findings that should
  encourage/discourage a practitioner from performing
  transrectal biopsy
  CDAI: Crohn’s Disease Activity
             Index
Number of liquid or soft stools each      X2
day for seven days
Abdominal pain (graded from 0-3 on        X5
severity) each day for seven days
General well being, subjectively
assessed from 0 (well) to 4 (terrible)
each day for seven days
Presence of complications*                X 20
Taking Lomitil or opiates for diarrhea    X 30
Presence of an abdominal mass (0 as       X 10
none, 2 as questionable, 5 as definite)
Absolute deviation of Hematocrit from     X6
47% in men and 42% in women
Percentage deviation from standard        X1
weight
COMPLICATIONS =Extraintestinal
symptoms (fever, uveitis, arthritis,
arthralgias, apthous ulcers, erythema
garnulusum, fissures, fistulas,
abscesses
http://www.ibdjohn.com/cdai/
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posted:10/14/2011
language:English
pages:15