S3836 At a Crossroad of Chronicity: Crohn's Disease and Endometriosis
Bibliographic record
Abstract
Introduction: Extra-pelvic Endometriosis is a rare and chronic condition that mimics symptoms associated with inflammatory bowel disease (IBD) including abdominal pain, diarrhea and in advanced disease hematochezia. We present a case of long standing ileocolonic Crohn’s Disease (CD) who subsequently found to have extra-pelvic endometriosis after acute small bowel obstruction. Case Description/Methods: Here we present a 44-year-old woman patient with a long-standing history of ileocolonic fibrostenotic CD (Montreal A1 L3 B2), Diarrhea-predominant IBS and small intestinal bacterial overgrowth. Her disease course has been complicated by loss of response and side effects to numerous medications including: 5-aminosalicylic acid, zzathioprine, infliximab, adalimumab, vedolizumab and certolizumab pegol. Due to this, she was started on risankizumab induction and maintenance in early 2023. On this medication she developed initial response with improve clinical symptoms and fecal calprotectin levels from 721 to 518 mcg/g. She remained stable for nearly a year before she experienced clinical signs of obstruction with post prandial pain and emesis. Magnetic resonance enterographydemonstrated an interval change with luminal narrowing with upstream dilation. Due to lack of response and development of a severe stricture, she underwent laparoscopic resection of terminal ileum. Her pathology demonstrated evidence of chronic active ileitis in addition to endometrial tissue present in the serosa and the outer muscle wall of the ileum. Discussion: Endometriosis, characterized by the presence of endometrial tissue outside the uterus, can manifest in various locations within the abdominal cavity. The bowel represents the third most common site of occurrence, following the ovaries and peritoneum. Patient with endometriosis typically present with dysmenorrhea, dyspareunia, and chronic pain, while other gastrointestinal symptoms include diarrhea, constipation, and tenesmus do occur. Consequently, patients may receive a misdiagnosis of Irritable bowel syndrome. In very rare situations, endometriosis can be responsible for abscesses, fistulae or in late-stage disease obstructive symptoms that mimic CD as in our patient. Although the pathophysiology of bowel endometriosis and CD differs markedly, previous research has consistently shown a strong link between these conditions. Endometriosis rarely involves the mucosa layers of the bowel, which precludes direct endoscopic visualization. This case demonstrates a rare co-existence of poorly controlled CD and bowel endometriosis presenting with small bowel obstructive.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.026 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".