Crohn ileitis and sacroiliitis

Case contributed by Dr Bruno Di Muzio

Presentation

Previous history of small bowel resection and partial colectomy. Presenting now with ongoing abdominal pain ? obstruction.

Patient Data

Age: 25 years
Gender: Male

CT Abdomen and pelvis

CT

Small bowel to the right colon anastomosis is demonstrated. There is an abnormal segment of distal small bowel measuring approximately 8 cm just proximal to the anastomosis, where there is circumferential thickening of the small bowel wall and stranding in the surrounding fat.

Multiple loops of small bowel are distended with transition points in the mid small bowel and in the region of the anastomosis. Contrast and gas have passed all the way to the rectum.

Small volume free fluid in the dependent portion of the pelvis.

Numerous prominent lymph nodes in the small bowel mesentery measuring up to 8 mm in short axis.

Multiple cysts in the spleen.

Widening of both sacroiliac joints with sclerosis on the erosions on the iliac sides of both joints in keeping with sacroiliitis.Squaring of vertebral bodies and anterior syndesmophyte formation in the lower thoracic spine.

Case Discussion

This case illustrates circumferential mural thickening and inflammation in the distal ileum, associated with free fluid in the pelvis, in keeping with active ileitis related to Crohn's disease.

Changes of bilateral sacroiliitis and lower thoracic spine spondylitis are consistent with enteropathic arthritis, which is a seronegative chronic inflammatory arthritis associated with the occurrence of an inflammatory bowel disease. 

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