Presentation
3 days of abdominal pain, vomiting, melena and fresh PR bleeding. Fevers. Warfarin for valve replacement. ? active bleeding, diverticulitis.
Patient Data
Several loops of the mid-small bowel are distended and one loop centrally demonstrates significant bowel wall thickening. The most thickened loop demonstrates extensive submucosal edema and overall reduction in contrast enhancement. The terminal ileum is unremarkable and there is no large bowel abnormality. The appendix is normal.
The mesenteric vessels are patent with no evidence of significant atheromatous disease or thrombosis. Moderate amount of pelvic free fluid as well as small amount of perisplenic and perihepatic fluid. Extensive mesenteric stranding surrounding the involved small bowel loops. No free gas.
There are few simple cysts in the kidneys and the right lower pole contains a small fat density angiomyolipoma. The gallbladder contains some slightly dense band of calcific debris. No biliary dilatation. The remainder of the solid organs are unremarkable. No lymphadenopathy.
Lung bases are clear. Ankylosis of the sacroiliac joints.
IMPRESSION
New small bowel wall thickening with extensive mesenteric fat stranding. Mild small bowel dilatation proximal to the inflamed segment. In the presence of bilateral ankylosis of the sacroiliac joints, features are most in keeping with Crohn disease.
Case Discussion
The patient had the diagnosis confirmed by a gastroenterologist and is managing well on immunomodulator medication.