Crohn disease - duodenum

Case contributed by Dr Bruno Di Muzio

Presentation

Epigastric pain and vomiting.

Patient Data

Age: 40 years
Gender: Female
CT

Abdomen and pelvis

Short segment of inflammation and stricture affecting the proximal duodenum (D1) with upstream gastric distention. Equivocal short wall thickening of the terminal ileum.  No signs of perforation. Incidental liver hemangiomas. 

MRI

Enterography

Persistent distension of the stomach is identified with a transition point in the pylorus or proximal duodenum.  There is an associated thickened wall with mucosal enhancement.
Thickened wall with mucosal enhancement is also demonstrated in the terminal ileum with a length of 7 cm.  The actual length is difficult to be assessed because of the insufficient distension.  There are no dilated small bowel loops.  No other abnormality is identified in the small bowel loops.  There is no evidence of free fluid in the abdomen and pelvis.

Two small hemangiomas are identified in the segment III of the liver, similar to the previous CT.

Conclusion:
Stricture in the distal stomach/proximal duodenum with mucosal enhancement, suggestive of chronic active disease.
Short segment of thickened wall with mucosal enhancement in the terminal ileum, suggestive of mild active disease.

Case Discussion

This patient has developed structuring Crohn disease at the proximal duodenum. She was managed with further gastroscopy and dilation of stricture.

Note is also made to incipient inflammation of the terminal ileum, best appreciated on MRE than on CT. This was further confirmed and followed up with bowel ultrasound. 
 

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Case information

rID: 74787
Published: 5th Mar 2020
Last edited: 5th Mar 2020
Inclusion in quiz mode: Included

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