"In the management of inflammatory bowel disease, recognizing disease progression and determining the right surgical timing is critical to ensuring optimal patient outcomes. Today, we examine a compelling case from Dar Al-Shifa Hospital, highlighting the value of sequential surgical intervention, therapeutic management, and thorough pathological evaluation." [ Surgical Management of IBD: A Case Study in Sequential Intervention] --- SECTION 1: Initial Presentation and Management (May 2023) [ Timeline graphic with the patient’s symptoms highlighted. Clinical data overlays for clarity.] NARRATOR: "This case features a 32-year-old female who presented with acute abdominal pain and constipation. Imaging revealed a classic coffee bean sign, confirming sigmoid volvulus. Notably, there was no prior history of chronic illness." [ Hospital admission footage, ] NARRATOR: "The patient was admitted to Dar Al-Shifa Hospital in May 2024 for urgent surgical intervention. After a consultation with Dr. Mohammed Aziz, she was placed under the care of Consultant Gastroenterologist Dr. Jamal Al-Talhi for comprehensive evaluation and long-term management." SECTION 2: First Surgical Intervention and Medical Management NARRATOR: "Dr. Mohammed Aziz performed the initial surgery to address the sigmoid volvulus. The procedure included: A three-port laparoscopic approach Division of the upper rectum using an EndoGIA stapler Bringing the descending colon through a Pfannenstiel incision End-to-end anastomosis with a CEEA stapler Placement of a Redivac drain." [ Recovery room footage, followed by monitoring graphics.] NARRATOR: "Post-operatively, Dr. Jamal Al-Talhi supervised the patient’s recovery, monitoring for complications and assessing the need for further interventions." SECTION 3: Disease Progression (June 2024) [ Imaging scans and clinical test reports are animated to show Crohn’s disease progression.] NARRATOR: "One month later, the patient developed chronic abdominal pain and small bowel obstruction. Further diagnostics revealed evidence of Crohn’s disease affecting the ileum, with a stricture that required surgical correction." SECTION 4: Second Surgical Intervention and Coordinated Care [ Detailed operative graphics for hemicolectomy and ileocolic anastomosis.] NARRATOR: "On June 30, 2024, Dr. Mohammed Aziz performed a laparoscopic hemicolectomy. This procedure involved: Managing the ileal stricture Side-to-side ileocolic anastomosis Placement of a Redivac drain for post-operative care." NARRATOR: "Post-surgery, the multidisciplinary team, led by Dr. Jamal Al-Talhi, ensured a seamless recovery, adjusted the medical therapy for Crohn’s disease, and monitored for recurrence." SECTION 5: Pathological Findings NARRATOR: "Pathological analysis by Dr. Suad I. Eldruki revealed: Non-caseating granulomas Chronic granulomatous colitis No evidence of malignancy These findings were consistent with Crohn’s disease and informed the long-term treatment strategy." SECTION 6: Total Colectomy and Long-Term Care NARRATOR: "In July 2024, under the expertise of Dr. Othman Al-Tagouri, the patient underwent a total colectomy to manage disease progression. The procedure included adhesiolysis and an end-to-end anastomosis between the terminal ileum and rectum." NARRATOR: "Post-operative care focused on early mobilization, wound care, and continuous follow-up by a dedicated care team to optimize outcomes." SECTION 7: Learning Points NARRATOR: "This case demonstrates several critical insights into managing complex inflammatory bowel disease cases: 1. Recognizing acute surgical emergencies like sigmoid volvulus 2. Coordinating medical care to uncover underlying conditions 3. Utilizing staged surgical interventions in complex cases 4. Relying on thorough pathology evaluations to guide decisions 5. Emphasizing multidisciplinary follow-ups for long-term success 6. The importance of detailed documentation in improving patient care outcomes." "This case illustrates the complexity of inflammatory bowel disease management and the necessity of timely surgical intervention, multidisciplinary care, and meticulous pathological evaluation to ensure the best outcomes for patients." "The patient and her family extend their heartfelt gratitude and appreciation to the medical team who provided exceptional care throughout the treatment journey, including: Dr. Mohammed Aziz, Consultant General Surgeon Dr. Othman Al-Tagouri, Consultant General Surgeon Dr. Jamal Al-Talhi, Consultant Gastroenterologist for their sincere efforts and dedication to delivering the highest standards of medical care. The family also expresses their deep gratitude to Dar Al-Shifa Hospital for providing a supportive and comprehensive treatment environment, as well as the medical and nursing staff for ensuring a successful recovery. Thank you all from the heart."