Endoscopic Care for Crohn's Stricture in a 28-Year-Old

Patient Profile

Age	28 years
Gender	Female
Occupation	Working Professional (Banking Sector)
City	Pune
Presenting Complaint	Recurring cramping pain in the lower-right abdomen, bloating after meals, unintended weight loss, and episodes of vomiting suggesting a partial blockage
Diagnosis	Severe Crohn’s disease of the terminal ileum with an inflammatory and partly fibrotic ileal stricture (narrowing)
Duration of Issue	Symptoms for around 2 years, previously labelled as “IBS” before referral
Previous Treatments	Antispasmodics and dietary changes for presumed IBS, with no prior endoscopic evaluation or IBD-specific therapy
Date of Procedure	November 2024 (diagnostic colonoscopy with balloon dilation)
Outcome	Excellent. Stricture relieved, symptoms resolved, remission achieved

Patient identity withheld per confidentiality guidelines. Patient name is not included, and all other fields are accurate.

The Problem

Condition

Crohn’s disease is a form of inflammatory bowel disease (IBD) that causes deep, patchy inflammation anywhere along the digestive tract, most often at the terminal ileum, where the small intestine meets the colon. In this patient the inflammation was severe and had been left undiagnosed for around two years, allowing the wall of the ileum to thicken and narrow into a stricture. On colonoscopy the affected segment showed the classic deep, linear ulcers and a “cobblestone” appearance, and the narrowed opening would not allow the scope to pass easily. The narrowing was partly inflammatory, meaning swelling that can settle with medication, and partly fibrotic, meaning early scarring, which is what produced her intermittent blockage symptoms.

Emotional & Psychological Impact

At 28 and early in her career, the patient had spent two years being told her symptoms were “just IBS” and stress. She had reorganised her entire life around unpredictable pain and bloating, declining work travel, avoiding restaurants, and skipping social plans for fear of an attack. The unexplained weight loss frightened her, and the repeated reassurance without answers had left her anxious and unheard. By the time she reached specialist care she was exhausted and worried she might need major surgery. Receiving a clear diagnosis and a minimally invasive plan was, in her words, an enormous relief after years of uncertainty.

Consultation & Treatment Plan

What Was Assessed During the Consultation?

Detailed symptom history covering the pattern of pain, post-meal bloating, vomiting episodes, bowel habit changes, and degree of weight loss
Inflammatory and nutritional bloodwork, including CRP, ESR, faecal calprotectin, haemoglobin, B12, iron, and albumin
Disease extent and severity mapped via ileocolonoscopy with biopsies, alongside cross-sectional imaging (MR enterography) to define stricture length and rule out abscess or fistula
Characterisation of the stricture, distinguishing the inflammatory component that responds to medication from the fibrotic component that requires dilation
Patient goals, namely relieving the obstruction, avoiding bowel-resection surgery if possible, restoring nutrition, and achieving lasting remission

Why This Endoscopic Approach Was Chosen

Dr. Kothari opted for an endoscopic diagnosis-and-treatment pathway combined with medical therapy, reserving surgery as a last resort. The reasoning is set out below.

Colonoscopy as the definitive diagnostic. Direct visualisation with biopsy confirmed Crohn’s disease and accurately located the stricture, ending two years of misdiagnosis as IBS.
Endoscopic balloon dilation over surgery. Because the stricture was short and accessible, through-the-scope balloon dilation could relieve the narrowing without removing any bowel, preserving intestinal length and avoiding open surgery.
Treat-to-target medical therapy. Biologic and immunomodulator therapy was started to control the underlying inflammation driving the disease, so the stricture would not simply recur.
Nutritional rescue. Correcting iron, B12 and protein deficits was prioritised to reverse weight loss and support healing.

Diagnostic Imaging and Documentation

Baseline endoscopic and cross-sectional imaging documented the severity of disease and confirmed the location and length of the stricture before any intervention. Colonoscopy demonstrated deep ulceration and a narrowed ileal stricture, while MR enterography showed terminal ileal wall thickening and narrowing.

Procedure, Step by Step

Bowel preparation completed and the patient assessed as fit for the procedure
Conscious sedation administered for comfort during ileocolonoscopy
Full colonoscopy performed, with the scope advanced to the terminal ileum to inspect the diseased segment
Targeted biopsies taken from ulcerated areas to confirm Crohn’s disease histologically and exclude other causes
The ileal stricture identified and assessed, with a through-the-scope balloon advanced across the narrowing under direct vision
Controlled, graded balloon dilation performed to gently widen the stricture and restore luminal patency
Post-dilation inspection confirmed an adequately opened lumen with no perforation or significant bleeding
Procedure concluded, with the patient monitored in recovery and started on the planned medical therapy

Procedure Facts

Procedure	Ileocolonoscopy with biopsy and through-the-scope balloon dilation
Duration	Approximately 45 to 60 minutes
Anaesthesia	Conscious sedation
Device Used	Through-the-scope (TTS) dilation balloon and biopsy forceps
Approach	Endoscopic (per-anal), with no incisions and no bowel resection
Intraoperative Complications	None. No perforation or significant bleeding
Hospital Stay	Day-care procedure, discharged the same day

Post-Procedure Results

The balloon dilation immediately relieved the obstruction, and the cramping pain and post-meal vomiting settled within days. With biologic therapy controlling the underlying inflammation, the patient regained appetite and steadily recovered the weight she had lost. At follow-up her inflammatory markers and faecal calprotectin had fallen into the normal range, confirming clinical and biochemical remission, all achieved without bowel-resection surgery.

Outcomes at a Glance

Outcome Metric	Result
Stricture and Obstruction	✔ Relieved. Lumen widened and blockage symptoms resolved
Inflammation (CRP and Calprotectin)	✔ Normalised, with biochemical remission achieved
Nutrition and Weight	✔ Appetite returned and lost weight regained
Surgery Avoided	✔ Yes. No bowel resection required
Patient Satisfaction	✔ Very high, with quality of life restored
Complications	✔ None

Post-Procedure Care and Recovery

Instructions Given to Patient

Begin with a soft, low-residue diet for the first few days, then gradually return to a normal balanced diet as tolerated
Take biologic and immunomodulator therapy exactly as prescribed to keep inflammation suppressed and prevent re-narrowing
Continue iron, B12 and other supplements as advised until nutritional stores are replenished
Watch for and report warning signs such as severe abdominal pain, persistent vomiting, fever, or blood in the stool
Avoid smoking entirely, as it worsens Crohn’s disease and increases relapse risk
Attend scheduled follow-up, including repeat colonoscopy to confirm mucosal healing and reassess the stricture

Recovery Timeline

Timeframe	What the Patient Can Expect
Day 1 to 3	Mild abdominal discomfort and bloating settle, light activity resumes, and a soft diet is followed
Week 1 to 2	Obstruction symptoms resolved, normal diet gradually reintroduced, and return to work
Week 4 to 6	Appetite and energy improve as biologic therapy takes effect, and weight begins to recover
Month 3	Inflammatory markers and calprotectin trend to normal, indicating clinical remission
Month 6 to 12	Follow-up colonoscopy confirms mucosal healing and durable patency, with remission maintained

Patient Feedback

“For two years I was told it was just IBS and stress. Getting an actual diagnosis was such a relief, even if it was scary at first. The procedure was far easier than I feared, and I went home the same day. I genuinely have my life back. I can eat normally and travel for work again without that constant fear of an attack.”

Profile: Female, 28 years, Working Professional, Pune

Procedure: Ileocolonoscopy with balloon dilation, Pune, November 2024

Surgeon: Dr. Ksheetij Kothari, Consultant Gastroenterologist

Disclaimer: This case study is for educational purposes. Individual results vary. Patient name withheld for confidentiality. Always consult a qualified gastroenterologist for diagnosis and treatment.