Adalimumab for the Management of Post-operative Crohn's Disease (CD)

Inclusion Criteria: * 18-70 years old at the time of screening * Male or female * Firs ileocolonic surgical resection ( * Evidence of both macroscopic as well an microscopic evidence of Crohn's disease in the resected intestinal segment * Patient able to undergo pre randomization screening no earlier then 14 days and no later then 45 days post operatively. * Patients may receive anti-TNF-agents (i.g. infliximab or adalimumab)previously * Patients may receive corticosteroids, 6MP/AZA, methotrexate, or mesalamine prior to surgery. * Antibiotics, or mesalamine, must be discontinued within the screening/baseline 4 week period. Patients on steroids may be enrolled as long as steroids are tapered off. * Remission as defined by a CDAI ≤ 150. * Women of childbearing potential, and men, must use medically acceptable methods of contraception \[surgical sterilization, IUD, hormonal preparations, or double barrier method (e.g. condom or diaphragm, and spermicide)\] throughout the study and for a period of 6 months after receiving the last injection. * Screening lab results must be within prespecified limits: Hemoglobin ≥ 8.8 g/dl; SGOT/SGPT \< 3 X the upper limit of normal; Neutrophil count ≥ 1.0 X 109/L \& lymphocyte cont of ≥ 0.5 X 109/L * Must have a documented PPD ≤ 5 mm, in patients taking steroids, within the month before randomization, or taking immunomodulators 2 months prior to randomization. Other patients must have documented PPD ≤ 10 mm prior to randomization. PPD must be preformed and documented by an appointed member of the investigatory stuff. Patients must have a normal chest radiograph (both posterior-anterior and lateral views), read by a certified radiologist, within 3 months prior to randomization. * Commitment to adhere to study protocol requirements * Negative stool cultures for enteric pathogens (Salmonella, Shigella, Campylobacter, Ova \& parasites), and negative clostridium difficile toxin assay in stool. * Patients are able to self-inject or have a designee or healthcare professional who can inject the study medication at the appropriate intervals. * Patient's with long standing (\>5Y), as well as recently diagnosed Crohn's disease ,will be eligible if they show radiologic (i.e. CT enterography, MR enterography , small bowel follow through) evidence, as well as laboratory (i.e. CRP, platelets level, fecal calprotectin, ESR ) evidence for an active inflammatory process within a 3 months period prior to the qualifying surgery Exclusion Criteria: * evidence of macroscopic inflammatory disease at the surgical margins or else ware, according to the surgeon * Patients who discontinued anti TNF-alpha agents due to loss of efficacy or tolerability issues. * Patients with temporary ileostomy. * Patients with longstanding quiescent CD undergoing surgery for the treatment of a fibrostenotic lesion, without an active inflammatory disease process in the resected segment. * Any of the following medications taken within 3 months prior to randomization: cyclosporine, tacrollimus, mycophenolate mofetil, or other investigational anti-inflammatory agents. Medication targeting the reduction of TNF-alpha (infliximab, golimumab, cetrolizumb pegol, etanercept), natalizumab, or other FDA approved biological agents may be administered up until to index surgery. * Patient who have an ongoing active infection within the baseline period: intra-abdominal abscess, enteric infection as determined by stool cultures for bacteria, parasites and clostridium difficile toxin, other serious systemic bacterial infection within 3 months before randomization (e.g. Pneumonia; pyelonephritis; meningitis). * Patients with active TB, patients in close contact to individuals with active TB, patients with latent TB whether receiving or not receiving prophylaxis. * Patient that have or had an opportunistic infection within the last 6 months * Patients seropositive to HIV, HBV, or HCV. Patients will be actively screened for HBV vaccination, and will be required to undergo vaccination according to international guidelines. * Patients having current signs/symptoms of severe or progressive systemic disease: any progressive/uncontrolled renal, hepatic, hematologic, gastrointestinal, endocrine, pulmonary, cardiac, neurologic, or psychiatric illness. * Patients after organ transplantation * Any current or known malignancies * Use of any investigational drug within 60 days prior to randomization * Current/frequent use of NSAIDS (i.e. regular use of NSAIDS for more than 3 times a week for longer than 7 consecutive days during the trial period). * Pregnant or lactating women * Concomitant substance or alcohol abuse * Subjects unable to self-inject or do not have a designee or healthcare professional who can inject the study medication. * Subject unable to comply with the planned schedule of study visits and study procedures. * Patients with short bowel syndrome * Patients with previous small bowel surgeries