Demographics:
25 years old, Male
Indication:
Diffuse abdominal pain
Findings
Lower chest
- No acute findings
Abdomen/Pelvis
- Extensive mural thickening, submucosal edema, and mucosal hyperenhancement involving the terminal ileum
- Upstream small bowel distension with loops of small bowel measuring up to 4 cm in diameter
- Additional segmental mural thickening and mucosal hyperenhancement extending from the descending colon through the rectum
- Peripherally-enhancing fluid collection adjacent to the cecum measuring 1.1 x 1 x 0.9 cm
- Peripherally-enhancing perirectal fluid and gas collections measuring 3 x 2 x 1 cm on the right, 1 x 0.7 x 0.5 cm more anteriorly on the right, and 1.5 x 1 x 0.5 cm on the left
- Enterocolonic fistula bridging the terminal ileum and sigmoid colon and adjacent enteroenteric fistula
- Small volume abdominopelvic ascites
- Diffuse mesenteric edema
- High attenuation material layering in the gallbladder, likely representing vicarious excretion of intravascular contrast material
MSK
- No acute findings
Diagnosis
Crohn disease with small bowel obstruction, fistulas, and abscesses
Sample Report
Findings concerning for active inflammatory bowel disease (most consistent with Crohn disease) with segmental inflammation of the terminal ileum and distal colon and rectum. Associated upstream small bowel distension, enteroenteric and enterocolonic fistulas, and pericecal and perirectal abscesses.
Discussion