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Ulcerative Colitis and Crohn's Disease
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I have grouped these two inflammatory bowel diseases together in recognition of the possible similarities in their appearances on abdominal plain film. They are not the same disease process.
Crohn's disease is an inflammatory disease of the gastrointestinal tract. The causative agent has not been positively identified
Plain Film Appearances
Crohn's disease (also known as granulomatous colitis when confined to the colon) may be indistinguishable from ulcerative colitis when confined to the colon. The plain film signs of Crohn's disease are as follows:
Patient's with fulminant Crohn's disease may be subject to daily abdominal radiographs where there is a possibility of toxic megacolon.
Abdominal Plain Film Signs Comment long gas-filled stricture can also be seen in other diseases including ulcerative colitis narrowed small bowel lumen not seen in ulcerative colitis small bowel obstruction indication of marked stenosis causing obstruction terminal ileum disease common site for inflammation of bowel in Crohn's disease skip lesions Crohn's lesions can be isolated lesions that occur anywhere in the GIT. Multiple isolated areas of inflammation are referred to as skip lesions bowel wall thickening sometimes seen in small bowel on plain film fistula inflammation affects whole wall thickness nd can lead to breakdown of wall and fistula formation associated with spinal arthropathy associated with sacroiliitis and ankylising spondylitis cobblestone appearance, particularly of terminal ileum seen on bariun follow-through examination intra-mural gas fulminant Crohn's disease can proceed to toxic megacolon with intra-mural gas
- The transverse colon is dilated and shows evidence of thumbprinting (black arrow)
- The descending colon has a thickened featureless wall and pockets of intra-mural gas (white arrow). Bowel wall does not normally exceed 2mm in thickness but may be up to 10mm in thickness with severe inflammatory bowel disease.
- Patient has known Crohn's disease
- Long narrowed segment of descending colon
- Appearances consistent with toxic megacolon
- This patient has known Crohn's disease and has had a previous ileo-colic anastamosis.
- There is evidence of dilation of the small bowel with thickened wall (white arrows)
- narrowed area of descending colon is probably normal (black arrow)
Small bowel follow-through on same patient. The small bowel is dilated (black arrow). The anatomy is abnormal because of a previous ileo-colic anastamosis. Note the reduced length of small bowel. There is at least one colonic fistula (white arrow)
Plain Film Appearances
psedopolyps (acute fulminant stage) lumpy impressions in bowel gas, islands of lumpy mucosa absence of faeces acute and chronic stages of disease featureless, ribbon-like, lead pipe colon active and quiescent stages fine mucosal granular pattern on barium enema may be faintly visible on plain film thumbprinting (active stage) caused by mucoal oedema loss of haustration of left colon non-active stage shortening of colon ? caused by fibrosis, longitudital muscle spasm
Latest page update: made by M.J.Fuller
, Dec 13 2010, 4:49 AM EST
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Keyword tags: crohns disease intraluminal gas portal-venous gas skip lesions terminal ilium toxic megacolon ulcerative colitis
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