Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Early intestinal obstruction after infliximab therapy in Crohn’s disease

Mitsuro Chiba; Yuichi Tanaka; Iwao Ono

Downloads: 0
Views: 39


There is scarce knowledge on early intestinal obstruction in Crohn’s disease (CD) after infliximab treatment. Therefore, we describe two cases of early intestinal obstruction in a series of 46 CD patients treated with infliximab. Both our two cases were 21-year-old men with newly diagnosed CD who were diagnosed with perianal disease 2 years previously. They were suffering from diarrhea and abdominal pain, but there were no symptoms indicating bowel obstruction. Radiographic studies revealed stenotic sites in the terminal ileum in both cases. In both cases, infliximab 300 mg was infused, after which their abnormal laboratory data as well as symptoms such as diarrhea and abdominal pain clearly improved. However, on the 11th or 13th day post-treatment, they presented abdominal distension with air-fluid levels on imaging studies. Ileocolonic resection was performed in both cases. Early intestinal obstruction after infliximab therapy is characterized by initial improvement of the symptoms and the laboratory data, which is soon followed by clinical deterioration. This outcome indicates that infliximab is so swiftly effective that the healing process tapers the stenotic site, resulting in bowel obstruction. Thus, although unpleasant and severe, the obstruction cannot be considered as a side effect but rather a consequence of infliximab’s efficacy. CD patients with intestinal stricture, particularly the penetrating type with stricture, should be well informed about the risk of developing intestinal obstruction after infliximab therapy and the eventual need for surgical intervention.


Infliximab, Ileus, Crohn’s Disease


Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn’s disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010;16(20):2484-95. 10.3748/wjg.v16.i20.2484.20503448

Chiba M, Tsuji T, Nakane K, et al. Induction with infliximab and a plant-based diet as first-line (IPF) therapy in Crohn disease: a single-group trial. Perm J. 2017;21(4):17-009.29035182

Chiba M, Tsuji T, Nakane K, Ishii H, Komatsu M. How to avoid primary nonresponders to infliximab in Crohn’s disease. Inflamm Bowel Dis. 2017;23(11):E55-6. 10.1097/MIB.0000000000001281.28991860

Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130(2):323-33. 10.1053/j.gastro.2005.11.030. 16472588.

D’Haens G, Van Deventer S, Van Hogezand R, et al. Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn’s disease: a European multicenter trial. Gastroenterology. 1999;116(5):1029-34. 10.1016/S0016-5085(99)70005-3.10220494

Toy LS, Scherl EJ, Kornbluth A, et al. Complete bowel obstruction following initial response to infliximab therapy for Crohn’s disease: a series of newly described complication. Gastroenterology. 2000;118:A569.

Vasilopoulos S, Kugathasan S, Saeian K, et al. Intestinal strictures complicating initially successful infliximab treatment for luminal Crohn’s disease. Am J Gastroenterol. 2000;95:2503.

Sandborn WJ, Hanauer SB. Infliximab in the treatment of Crohn’s disease: a user’s guide for clinicians. Am J Gastroenterol. 2002;97(12):2962-72. 10.1111/j.1572-0241.2002.07093.x.12492177

Chiba M, Nakane K, Takayama Y, et al. Development and application of a plant-based diet scoring system for Japanese patients with inflammatory bowel disease. Perm J. 2016;20(4):62-8.27768566

Hanauer SB, Sandborn W, Practice Parameters Committee of the American College of Gastroenterology. Management of Crohn’s disease in adults. Am J Gastroenterol. 2001;96(3):635-43. 10.1111/j.1572-0241.2001.03671.x.11280528

Greenstein AJ, Lachman P, Sachar DB, et al. Perforating and non-perforating indications for repeated operations in Crohn’s disease: evidence for two clinical forms. Gut. 1988;29(5):588-92. 10.1136/gut.29.5.588.3396946

Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn’s disease. Gastroenterology. 2006;130(3):650-6. 10.1053/j.gastro.2005.12.019.16530505

Solberg IC, Vatn MH, Høie O, et al. Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007;5(12):1430-8. 10.1016/j.cgh.2007.09.002.18054751

Rutgeerts P, D’Haens G, Targan S, et al. Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease. Gastroenterology. 1999;117(4):761-9. 10.1016/S0016-5085(99)70332-X.10500056

Lichtenstein GR, Olson A, Travers S, et al. Factors associated with the development of intestinal strictures or obstructions in patients with Crohn’s disease. Am J Gastroenterol. 2006;101(5):1030-8. 10.1111/j.1572-0241.2006.00463.x.16606351

Bouhnik Y, Carbonnel F, Laharie D, et al. Efficacy of adalimumab in patients with Crohn’s disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study. Gut. 2018;67(1):53-60. 10.1136/gutjnl-2016-312581.28119352

Louis E, Boverie J, Dewit O, Baert F, De Vos M, D’Haens G. Treatment of small bowel subocclusive Crohn’s disease with infliximab: an open pilot study. Acta Gastroenterol Belg. 2007;70(1):15-9.17619533

Chiba M, Sugawara T, Tsuda H, Abe T, Tokairin T, Kashima Y. Esophageal ulcer in Crohn’s disease: disappearance in 1 week with infliximab. Inflamm Bowel Dis. 2009;15(8):1121-2. 10.1002/ibd.20769.18942761

Torres J, Boyapati RK, Kennedy NA, Louis E, Colombel JF, Satsangi J. Systematic review of effects of withdrawal of immunomodulators or biologic agents from patients with inflammatory bowel disease. Gastroenterology. 2015;149(7):1716-30. 10.1053/j.gastro.2015.08.055.26381892

Sorrentino D. Role of biologics and other therapies in stricturing Crohn’s disease: what have we learnt so far? Digestion. 2008;77(1):38-47. 10.1159/000117306.18285676

Pelletier AL, Kalisazan B, Wienckiewicz J, Bouarioua N, Soule JC. Infliximab treatment for symptomatic Crohn’s disease strictures. Aliment Pharmacol Ther. 2009;29(3):279-85. 10.1111/j.1365-2036.2008.03887.x.19035967

Fumery M, Seksik P, Auzolle C, et al. Postoperative complications after ileocecal resection in Crohn’s disease: a prospective study from the REMIND Group. Am J Gastroenterol. 2017;112(2):337-45. 10.1038/ajg.2016.541.27958285

Kotze PG, Saab MP, Saab B, et al. Tumor necrosis factor alpha inhibitors did not influence postoperative morbidity after elective surgical resection in Crohn’s disease. Dig Dis Sci. 2017;62(2):456-64. 10.1007/s10620-016-4400-2.27933472




5c3cdb920e88251509cd6225 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections