Presentation
Recurrent generalized abdominal pain, more at right lower abdomen, associated with anorexia and mild weight loss
Patient Data
Significant circumferential thickening and enhancement of the distal 15-20 cm of small bowel as well as ileocecal junction, causing narrowing of its lumen (string sign) as well as prominent surrounding mesenteric vessels (comb sign) with mild dilatation of the bowel proximal to this segment.
Clear surrounding fat planes with no pneumoperitoneum, excluding perforation or fistulous communication. No ascites detected.
Case Discussion
Classic findings of active inflammatory Crohn disease of the distal ileum with mural thickening, hyper-enhancement, the "comb sign" of mesenteric congestion and mild proximal small bowel dilatation. Endoscopic studies such as enteroscopy 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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