Ileoileal fistula (Crohn disease)
Known patient of Crohn disease since 17 years with on and off episodes of abdominal pain. Came for a routine screening to assess present extent of disease.
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Long segment circumferential mural thickening and stratification involving terminal ileum with engorged vasa rectae (Comb sign), mesenteric fatty proliferation. Nipple like projection from superior margin of terminal ileum with a fistuluous track to another inflamed loop of terminal ileum. No abdominal collections. No free peritoneal air.
Ileoileal and ileocutaneous / colocutaneous fistulas, abscesses in abdomina are common complications encountered in inflammatory bowel disease. During the episodes of flare up / active disease, mucosal hyperenhancement in post contrast studies confirm activity. In the previous studies (not included here), localized collections were seen at the site of present fistulations, suggesting the chronic development of a fistula off a pre existing wall of inflammation. The general dictum of abscess has to drain is what happens heres as well with interbowel fistulations providing inflammatory relief.