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Crohn's disease after ileal resection — ESEGH MCQ

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HardInflammatory Bowel DiseaseCrohn's disease after ileal resectionESEGH

After 45 cm terminal-ileal resection, a patient has macrocytosis, glossitis, paraesthesia and B12 92 ng/L; folate and ferritin are normal. What mechanism best explains the syndrome?

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Correct answer: A — Vitamin B12 malabsorption after terminal-ileal resection

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

C is correct. The terminal ileum absorbs intrinsic-factor–B12 complexes, so substantial resection causes deficiency with megaloblastosis and neurological injury. A usually causes microcytosis; B does not cause this deficiency phenotype; D would need haemolysis evidence and does not explain low B12; E is generally normocytic and neurologically silent.

Reference: BSG IBD guideline 2019 full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC6872448/