SBO secondary to ileal stricture from Crohn's disease

Case contributed by Dr Craig Hacking

Presentation

Generalised abdominal pain and distension. Multiple surgeries. Confused so no further Hx available.

Patient Data

Age: 85 years
Gender: Male

Multiple loops of dilated jejunum and ileum, measuring up to 3.5 cm in diameter. The lead point arises from the terminal ileum which appears narrowed and thickened with surrounding fat-stranding. Normal bowel wall enhancement, no evidence of pneumatosis. The colon is collapsed. The ascending colon appears shortened, with the appearance of a high-riding caecum - this may represent previous resection.

Further fat-stranding is seen within the mesentery of the ileum, with a small amount of fluid evident within the right side of the pelvis, right paracolic gutter and surrounding the inferior liver margin. No free gas within the abdomen or pelvis. Normal contrast enhancement within the SMA.

Calculi evident within the gallbladder, no secondary signs of inflammation. The kidneys have an atrophic appearance, with a lobulated exophytic renal cyst on the right. Small hiatus hernia noted. The liver, pancreas, spleen and adrenals appear normal. The urinary bladder and collecting systems are unremarkable.

No enlarged abdominal, pelvic or inguinal lymph nodes.

The visualised lung bases are clear. Bilateral pars defects of L5 with mild anterolisthesis with respect to S1. No acute osseous pathology identified.

Conclusion
Small bowel obstruction due to a inflammatory stricture of the terminal ileum in a patient with known Crohn's disease. No evidence of perforation.

Case Discussion

The patient had a known Hx of Crohn's disease. He proceeded to laparotomy for terminal ileal resection.

Histology = Crohn's stricture

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Case information

rID: 56030
Published: 6th Oct 2017
Last edited: 6th Oct 2017
Inclusion in quiz mode: Included

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