NMS. Casos Clínicos

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Chapter 8 ♦ Lower Gastrointestinal Disorders

Characteristics

Crohn Disease

Ulcerative Colitis

Increased incidence of carcinoma that progressively increases with duration

Natural history

Rarely goes into complete remission Tends toward obstruction, local infection, and fistulas Poor nutrition Increased incidence of carcinoma but less than with ulcerative colitis

Q: How could you confirm the diagnosis? A: CT of the abdomen would be useful because it might demonstrate the area of stenotic bowel in the terminal ileum (Fig. 8-9). It could also help determine the existence of any complications such as perforation or formation of an abscess or fistula. In addition, it might suggest another diagnosis (e.g., tumor).

Figure 8-9: Crohn disease with terminal ileal stricture. Coronal image from a CT enterography shows wall thickening and inflammation of a short segment of the terminal ileum (arrow). The bowel proximal to the inflamed segment is dilated (*) as the result of a stricture. Strictures in Crohn disease usually have a combination of active inflammation and fibrosis. (From Klein J, Brant WE, Helms CA, Vinson EN. Brant and Helms’ Fundamentals of Diagnostic Radiology , 5th ed. Wolters Kluwer Health; 2018, Fig. 69-29.) SAMPLE