Crohn disease (colitis and large bowel stricture)

Case contributed by Dr Bruno Di Muzio

Presentation

Abdominal distension and pain. Elevated CRP, normal WCC.

Patient Data

Age: 20 years
Gender: Female
CT

CT Abdomen and pelvis

Features of a long segment of colitis involving most of the transverse and descending colons characterized by wall thickening in up to 7 mm and a stricture point just after the hepatic flexure of the colon with mild upstream distention of the descending colon. The distal ileum shows an 8cm segment of mild wall thickening (3.5 mm) with no upstream bowel distension (2.8 cm). Another segment of mural thickening (4.0mm) is identified in the proximal ileum, measuring about 4 cm in extension, and associated with upstream distension (3.5 cm). All those segments show associated prominent vasa recta. No signs of fistulas or abscess. Small mesenteric lymph nodes are reactive by size criteria. No free fluid in the peritoneal cavity. Signs of liver steatosis, solid viscera otherwise unremarkable.   

MRI

MRI Enterography

Features of a long segment of colitis involving most of the transverse and descending colons characterized by wall thickening in up to 7 mm and a stricture point just after the hepatic flexure of the colon with mild upstream distention of the descending colon. No signs of active inflammation within the small bowel. 

Case Discussion

This case shows a patient presenting on the CT images with features of active inflammatory small and large bowel Crohn’s disease with luminal narrowing. No complications of penetrating disease were identified. The patient was managed clinically. Colonoscopy confirmed the colonic stricture and inflammatory disease. MRE followup showed persistent stricture and active disease within the colon, surgical management with partial colectomy was then offered. 

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Case information

rID: 59011
Published: 17th Mar 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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