Cobblestoning - terminal ileum

Case contributed by Dr Matt A. Morgan

Patient Data

Age: 20 years
Gender: Female
Barium

Small bowel follow through

There is an approximately 10 cm length of irregular nodular fold thickening in the terminal ileum with transverse and linear ulcerations ("cobblestoning").

The round radiopaque object is a 12.5 mm barium tablet that has been intentionally placed into the field of view to allow better measurements (internal control for magnification).

Case Discussion

As Crohn disease (or other bowel inflammation) progresses it accumulates both longitudinal and transverse linear ulcerations, which on a background of nodular wall edema, gives the appearance of a cobblestone road when barium seeps into the deep crevices of the ulcerations ("cobblestoning"). It is uncommonly seen in isolation, but is one of a number of findings in advanced Crohn disease.

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Case information

rID: 85694
Published: 5th Jan 2021
Last edited: 15th Mar 2021
Inclusion in quiz mode: Included
Institution: University of Pennsylvania

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