Complicated Crohn disease

Case contributed by Yaïr Glick


Right flank pain for past 2-3 weeks.

Patient Data

Age: 20 years
Gender: Male

Asthenic build.
Retroperitoneal abscess centered in the iliopsoas muscle, measuring 13.5 x 5.1 x 10.3 cm, containing air-fluid level and numerous gas bubbles. Elongated, cranially pointing retrocecal tubular structure with thick walls measuring 18 mm in diameter, probably representing the appendixFistula from the base of the cecum, coursing posterior to the appendix and into the abscess. Anterosuperior extension of abscess into hepatorenal fossa. The cecumascending colon and terminal ileum show substantial wall thickening with narrowed lumen and pronounced fat stranding.
Splenule embedded in the pancreatic tail.

On same day


Pigtail drain inserted under ultrasound and fluoroscopic guidance. Pus received and sent for culture.

1 week later


The abscess has enlarged slightly, despite the pigtail catheter curled in its medial aspect, and now measures 15.1 x 6.4 x 10.3 mm. The amount of purulent content has increased, while the amount of gas has decreased. The cecum, ascending colon and terminal ileum still show significantly thickened walls and fat stranding.

18 days later