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Crohn disease (terminal ileum active inflammation and strictures)

Case contributed by Bruno Di Muzio
Diagnosis almost certain

Presentation

Abdominal pain and distension.

Patient Data

Age: 25 years
Gender: Female

There are three short segments (~5 cm) of distal ileum wall thickening (~4 mm) and hyperenhancement associated with luminal narrowing and upstream small bowel distension (~3.5 cm).  A jejunal 8 cm long segment of wall thickening and hyperenhancement is not convincingly causing a stricture. A small amount of free fluid in the peritoneal cavity. No signs of fistulas or abscess. The bowel is otherwise unremarkable. Prominent mesenteric lymph nodes are likely reactive by size criteria. Cholecystectomy. The liver is unremarkable, portal vein is patent. No signs of renal stones. The remaining abdominal viscera are unremarkable. 

Case Discussion

Small bowel active inflammatory skip segments with strictures in the distal ileum in keeping with the patient's known Crohn disease.  

Strictures in patients with Crohn are defined as small bowel segments that show luminal narrowing with associated proximal/upstream bowel dilation (over 3 cm in caliber). The dilation can be graded as mild (3-4 cm) or severe (>4 cm).

In cases like this one, when strictures are associated with active inflammatory changes, conservative medical treatment is the first option. 

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