Chronic active Crohn's disease - Example 3
This 45-year-old white female patient has had confirmed Crohn’s disease for 5 years. She now reports abdominal pain and bloating. Bowel movements have been generally unremarkable. Ultrasound and radiography reveal a long stretch of stenosis in the terminal ileum.
The examination begins in the terminal ileum. The mucosa has undergone polypous change and the lumen is stenotic. The mucosa is vulnerable. One sees longitudinally oriented, deep ulcerations and pseudopolyps. Bauhin’s valve is narrow and also inflamed. In the cecum, findings change suddenly: There is normal mucosa with haustrations and normal vascular structure.
The endoscopic diagnosis of Crohn’s disease is not difficult to make based on these endoscopic findings. Involvement of the terminal ileum, the typical ulcerations and the completely normal mucosa of the entire colon point to the diagnosis. If these findings are returned at a patient’s first colonoscopy, work-up should be extended to other inflammatory changes, such as seen in patients with tuberculosis.
(see also commentary to Example 1 and Example 2).