GI Radiology > Colon > Inflammatory Diseases > Crohn's Disease

Inflammatory diseases

Crohn's Disease

Crohn's Disease is an idiopathic inflammatory disease of the GI tract that is characterized by ulcerations, erosions, noncaseating granulomas, and full-thickness bowel wall inflammation. Patients usually present in their twenties or thirties with abdominal pain, diarrhea, weight loss, and occasionally fever. The disease may affect any portion of the gastrointestinal system from the esophagus to the anus. The course is progressive in nature, with frequent remissions and relapses. The radiographic hallmarks of Crohn's disease are aphthous erosions, thickened and distorted folds due to bowel wall edema, "cobblestone" pattern of deep ulcerations, fibrosis with thickened walls, contractures, and stenosis resulting in the "string sign," fistula and sinus tract formations, stranding in mesenteric fat due to inflammation, and "skip" lesions with intermittent areas of normal bowel between diseased segments.

Treatment of Crohn's is directed towards symptomatic improvement and may consist of empiric corticosteroids or immunosuppressive drugs, 5-aminosalicylic acid agents, antibiotic, and occasionally dietary changes. Surgical intervention is indicated if the disease is resistant to medical therapy, or if the patient develops massive bleeding, intra-abdominal abscess, or obstruction with fibrous stricture, but recurrence of disease is common.

Abdominal X-ray of Crohn's disease patient showing transmural colonic inflammation (arrows) and ileal abnormalities


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