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Small bowel obstruction - Crohn disease

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Chronic abdominal pain and vomiting.

Patient Data

Age: 35 years
Gender: Male

Markedly dilated small bowel loops with multiple inflammatory strictures showing mural thickening and enhancement.

Multiple enlarged mesenteric lymph nodes.

Engorged vasa recta.

Annotated image

Markedly dilated small bowel loops (Yellow arrows) with multiple inflammatory strictures (Red arrows) showing mural thickening and enhancement.

Case Discussion

In Crohn's disease, it's important to discriminate between active inflammation and fibrostenotic disease;

Active inflammation, characterized clinically by acute clinical symptoms & raised inflammatory markers and treatment is usually medical (unless there is a complication).

Whilst fibrostenotic disease, is characterized by obstructive symptoms and is often treated surgically.

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