Successful treatment of ileocolonic anastomotic stricture with ustekinumab in Crohn’s disease: a case report

Background: The role of medical therapy in treating anastomotic strictures in Crohn’s disease (CD) is largely unknown, but a previous study reported the use of ustekinumab and vedolizumab for a non-obstructing primary stricture in a reported case. This case illustrates ustekinumab enabling endoscopic treatment of a near totally occluded stricture, thus re-establishing luminal patency. Case Description: A 78-year-old biologic-naïve woman with CD had symptoms of partial bowel obstruction, after an undergoing closure of the defunctioning loop ileostomy that was created at the time of a previous emergency subtotal colectomy and ileosigmoid anastomosis for colonic perforation. Gastrografin enemas and a flexible sigmoidoscopy showed a near completely occluded ileosigmoid anastomotic stricture where the lumen could not be identified and hence not traversed even with a 5.4-mm endoscope. The patient was given a 390-mg intravenous dose of ustekinumab, resulting in a partially opening of the stricture 2 weeks later, which allowed for endoscopic strictureplasty. The patient showed improvement in symptoms and stricture, and surgery could be avoided. Conclusions: Nearly completely occluded strictures due to combined anastomotic fibrosis and inflammation that cannot be managed endoscopically may benefit from initial treatment with ustekinumab. This might help establish luminal patency allowing endoscopic stricture treatment, thus avoiding or postponing surgery.