Amine Zoughlami, Alessandro Pedicelli, Jonathan M Wyse
{"title":"When Bowel Preparation Worsens With Time: The Case of an Unknown Crohn's Fistula.","authors":"Amine Zoughlami, Alessandro Pedicelli, Jonathan M Wyse","doi":"10.14309/crj.0000000000001730","DOIUrl":null,"url":null,"abstract":"<p><p>Colonoscopy is essential for diagnosing and managing lower gastrointestinal diseases, but adequate bowel preparation is critical for success. We report the case of a 66-year-old man with quiescent Crohn's disease who experienced repeated bowel preparation failure despite adherence to intensified regimens. Imaging later revealed an ileo-sigmoid fistula diverting laxative flow, preventing proximal colonic cleansing and causing stool reaccumulation in distal segments. Internal fistulas, common in Crohn's disease, are often asymptomatic but can significantly impair preparation quality. This case highlights the need to consider anatomical abnormalities such as internal fistulas in patients with recurrent bowel preparation failure and poor visualization during colonoscopy.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 6","pages":"e01730"},"PeriodicalIF":0.5000,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180838/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACG Case Reports Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14309/crj.0000000000001730","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Colonoscopy is essential for diagnosing and managing lower gastrointestinal diseases, but adequate bowel preparation is critical for success. We report the case of a 66-year-old man with quiescent Crohn's disease who experienced repeated bowel preparation failure despite adherence to intensified regimens. Imaging later revealed an ileo-sigmoid fistula diverting laxative flow, preventing proximal colonic cleansing and causing stool reaccumulation in distal segments. Internal fistulas, common in Crohn's disease, are often asymptomatic but can significantly impair preparation quality. This case highlights the need to consider anatomical abnormalities such as internal fistulas in patients with recurrent bowel preparation failure and poor visualization during colonoscopy.
期刊介绍：
ACG Case Reports Journal is a peer-reviewed, open-access publication that provides GI and hepatology fellows, private practice clinicians, and other healthcare providers an opportunity to share interesting case reports with their peers and with leaders in the field. ACG Case Reports Journal publishes case reports, images, videos and letters to the editor in all topics of gastroenterology and hepatology, including: Biliary Colon Endoscopy Esophagus Functional Bowel Disorders Inflammatory Bowel Disease Liver Nutrition and Obesity Pancreas Pathology Pediatric Small Bowel Stomach.
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