Presentation
Chronic abdominal pain and vomiting.
Patient Data
![](https://prod-images-static.radiopaedia.org/images/7314101/f08559da0310cd81cb7fb67617a270a434422caf3eb2911d215e1f59ab8e9d63_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/7314305/7f949c2f4e8d41262bd65ab5c1b3563ce3560d92f6046f81f81fe01445ef412f_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/7313805/d49cb87a054166938c7d40357979c071c6a9b916fbd89bb85a60ff65d0e19247_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/7314429/d709d2bcb7f2a6ce60730d6bee72e0cb3b7bfb719e61c758ac265134dbdcf82b_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/7314101/f08559da0310cd81cb7fb67617a270a434422caf3eb2911d215e1f59ab8e9d63_big_gallery.jpeg)
Markedly dilated small bowel loops with multiple inflammatory strictures showing mural thickening and enhancement.
Multiple enlarged mesenteric lymph nodes.
Engorged vasa recta.
![](https://prod-images-static.radiopaedia.org/images/7315481/9add7f17c16e9a80663f599e15cb3c_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/7315489/ee8948c893764c4b04c2e0be8812e2_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/7315497/8f3d52a573b1c764959d6d52c4c259_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/7315481/9add7f17c16e9a80663f599e15cb3c_big_gallery.jpeg)
Markedly dilated small bowel loops (Yellow arrows) with multiple inflammatory strictures (Red arrows) showing mural thickening and enhancement.
Case Discussion
In Crohn's disease, it's important to discriminate between active inflammation and fibrostenotic disease;
Active inflammation, characterized clinically by acute clinical symptoms & raised inflammatory markers and treatment is usually medical (unless there is a complication).
Whilst fibrostenotic disease, is characterized by obstructive symptoms and is often treated surgically.