Woman with abdominal pain and Diarrhoea

Saturday, January 2, 2010
This is a double-contrast barium enema obtained 18-year-old woman who was complaining of insidious onset progressive type abdominal pain and Diarrhoea.Identify the changes that you can see & what is the Dx?




ANSWER - Crohn's disease


Crohn's disease is a disorder  that is characterised pathologically by involvement of all bowel wall layers in a chronic inflammatory process with non-caseating granulomas. 

Macroscopic appearance 
  • Skip lesions
  • Cobblestone ulceration
  • Lead pipe thickening
  • Narrowed lumen
  • Strictures
  • 'Rose-thorn' narrow-mouthed ulcers which lead to fistulae
  • Fistulae, often between adherent bowel and/or bladder, vagina, other abdominal organs or the abdominal wall
  • Mesenteric fat covering serosa
  • Enlarged mesenteric nodes
CLINICAL FEATURES
  • Abdominal pain
  • Weight loss
  • Diarrhoea
INVETIGATIONS
Imaging
  • Small bowel contrast study there may be strictures, fistulae and ulceration - rose thorn ulcers - and cobblestone mucosal surfaces. Kantor's string sign - luminal narrowing of the ileum
  • Large bowel enema may demonstrate discontinuous skip lesions with normal bowel between, a ragged luminal outline due to ulceration, and loss of haustration. Other features may include rose thorn ulcers and pseudo-diverticulae caused by fibrotic stricturing.
Other tests
  • Blood tests
  • Endoscopy: both upper and lower GI endoscopy.
  • Histology
Comparison of ulcerative colitis with Crohn's disease
  • Bloody diarrhoea is seen in nearly all patients with ulcerative colitis
  • Radiologically, UC is a symmetrical, continuous disease causing shallow ulcers but very rarely strictures and never any fistulae.
  • Crohn's is discontinuous with deep ulcers with common strictures and fistulae.

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5 comments

  1. shameel Says:
  2. skip lesions, contrast appearin as tracks in intestine showin fissures..
    so is it crohn's disease?
    pls post correct answer for all qs..

     
  3. Anonymous Says:
  4. Yes, Please post the correct answer for all questions posted !

     
  5. dr.ainulwara Says:
  6. double contrast shows deep ulcers involving large bowel with normal segment which is dilated: ulcerative collitis with its complication of toxic megacolon

     
  7. xydau Says:
  8. Deep ulcers & skip lesions that we can see here are characteristic features of crohn's disease.But Alone with This image its difficult to differentiate Crohn's from UC.But in UC dysentry is almost always seen in patients.I would like to discuss this more!!!

     
  9. Anonymous Says:
  10. there's a normal segment both distal and proximal to the ulcerated segment, UC involves all distal colon. more likely crohn's disease

     

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