Crohn ileitis

Case contributed by Dr Vikas Shah


Right iliac fossa pain and raised temperature. Vague mass in right iliac fossa on examination.

Patient Data

Age: 30 years
Gender: Male

Circumferential thickening and enhancement of the distal 15-20 cm of small bowel with mild dilatation of the bowel proximal to this segment. The associated mesentery is congested. A small volume of free fluid is noted in the region but there is no collection or perforation. Several mildly enlarged nodes in the small bowel mesentery but no definite signs of proximal small bowel disease. Normal large bowel.

Case Discussion

Classic findings of active inflammatory Crohn disease of the terminal ileum with mural thickening, hyperenhancement, the "comb sign" of mesenteric congestion and mild proximal small bowel dilatation. Endoscopic studies such as enteroscopy or capsule endoscopy, or radiology studies with luminal distension such as CT enterogram, MRI enterogram or barium follow-through provide a better assessment of the proximal small bowel.

Biopsies confirmed small bowel Crohn disease in this case.

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