Crohn's disease

Case contributed by Dr Dalia Ibrahim

Presentation

Abdominal pain and diarrhea.

Patient Data

Age: 25 years old
Gender: Female
CT

The terminal ileum, the sigmoid and descending colon show mural thickening and contrast enhancement of the mucosa, 

Prominent perienteric and pericolic vasculature highlighted by fibrofatty proliferation of the mesentery

Vascular dilatation and tortuosity of the vasa recta giving the (comb sign)

Few enlarged pericolic and mesenteric lymph nodes. 

Case Discussion

Endoscopy & biopsy proven case of "Crohn's disease"

Crohn's disease, like ulcerative colitis, is an idiopathic inflammatory bowel disease (IBD), characterised by widespread gastrointestinal tract involvement, typically with skip lesions - thereby its synonym regional enteritis - and frequently systemic involvement.

CT examination can be carried out with both intravenous and intraluminal contrast (positive or negative).

  • fat halo sign
  • comb sign
  • bowel wall enhancement
  • bowel wall thickening (1-2cm) which is most frequently seen in the terminal ileum (present in up to 83% of patients) .
  • strictures and fistulae
  • mesenteric / intra-abdominal abscess or phlegmon formation 
  • abscesses are eventually seen in 15-20% of  patients.

 The comb sign refers to the hypervascular appearance of the mesentery in active Crohn's disease.  Fibrofatty proliferation and perivascular inflammatory infiltration outline the distended intestinal arcades. This forms linear densities on the mesenteric side of the affected segments of small bowel, which give the appearance of the teeth of a comb. 

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Case information

rID: 28862
Case created: 17th Apr 2014
Last edited: 18th May 2017
Inclusion in quiz mode: Included

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