Efficacy and Safety of Risankizumab in a Patient With Complex Crohn's Disease and a High-Output Ileostomy: A Case...

The management of Crohn's disease (CD) in patients with a history of multiple abdominal surgeries and a high-output stoma represents a significant therapeutic challenge. Risankizumab, an interleukin-23 inhibitor, has proven efficacy for moderate-to-severe CD, but its role in complex post-surgical scenarios is not well-documented. We present the case of a 46-year-old male patient with longstanding, penetrating, and stricturing ileocolonic CD. Following multiple surgeries, including the creation of a permanent end ileostomy for an anastomotic leak, he developed a high-output stoma. Risankizumab was initiated in December 2024 as postoperative prophylaxis. By June 2025, ileoscopy confirmed endoscopic remission (Rutgeerts score i0) with no postoperative recurrence. This case demonstrates that risankizumab is highly effective for achieving and maintaining endoscopic remission in complex, post-surgical CD. However, it also highlights that achieving disease remission does not necessarily resolve severe surgical complications. The management of such patients necessitates a multidisciplinary approach to address both the underlying inflammatory bowel disease (IBD) and its complications.