Expect the unexpected: A case of penetrating Crohn's disease complicated by foreign body ingestion

A 17-year-old nonverbal male with autism spectrum disorder (ASD) presented with abdominal pain, diarrhea, and weight loss. Initial workup revealed penetrating Crohn's disease (CD) with an ileosigmoid fistula and abscess. After initial improvement with antibiotics, enteral nutrition (EN), and infliximab (IFX), he developed recurrent abdominal pain and elevation of inflammatory markers. Repeat imaging suggested disease progression, prompting surgical intervention. During ileocecal resection and fistula takedown, a foreign body (the hand of an action figurine) was discovered, likely contributing to bowel obstruction and abscess recurrence. This case highlights the importance of medical and surgical comanagement of penetrating CD, as well as the need to maintain a broad differential diagnosis when new or worsening symptoms arise.