[bharat]

little confusing but my thinking in this case are as follow
"complaining of purulent discharge from his abdomen."
"He developed pain in that area starting about a week prior to his visit."
"A palpable mass formed that is painful to palpation and that began to drain pus 1 day ago." -------->indicative of abscess or fistula....but what is the reason?
well the history of "partial right hemicolectomy approximately 20 years ago for complications stemming from his Crohn disease"----->so i think it is remission of Crohns disease again because........................
1)remission of crohns disese is very common
2)the perforation appeared just next to "well-healed midline incision scar" of surgery 20 yrs. ago......but not after the short period of surgery which rule out the any abscess developed as a surgical complication
3)some positive feature that he has active inflammation are:-
serum laboratory testing ------> remarkable for leukocytosis
4) an elevated C-reactive protein :- although non specific but it is marker of inflammation or cancer
5)low albumin:- it is obvious after surgery for crohns disease and still it may be due to insufficient intake or absorption from gut wall
although there are no specific complication of crohns disease like diarrhea or LQ pain but what can be the possible reason??????????? ..........................waiting for your reply