High-Grade Small Bowel Dysplasia Following Prior Adenocarcinoma in Small Bowel Crohn's Disease

Patients with Crohn's disease are at increased risk of small bowel adenocarcinoma due to chronic inflammation, though absolute incidence is low and surveillance guidelines are unclear. We report a patient with long-standing small bowel Crohn's disease and prior adenocarcinoma who developed high-grade dysplasia despite clinical, biochemical, and endoscopic remission on biologic therapy. An asymptomatic rise in fecal calprotectin prompted imaging and device-assisted enteroscopy, revealing a non-traversable stricture. Surgical resection confirmed high-grade dysplasia with negative margins. This case underscores persistent malignancy risk in fibrostenosing Crohn's disease and the importance of biomarkers and advanced diagnostics in high-risk patients.