There is an irregular narrowing of the lumen of the ileum, possible cobblestoning (black arrowheads), and a coned cecum (white arrowheads). These spot films of the terminal ileum show a fixed ileum displaced by mass or mesenteric retraction secondary to inflammatory disease.
This is a 25 year old white female who was diagnosed with Crohn's in 1992 by exploratory laporotomy performed secondary to abdominal pain. Since that time the patient has been admitted to the hospital three times and has been on Prednisone. She has experienced intermittent mild abdominal pain, approximately 3-4 times per week. During severe exacerbations of her disease, she experiences numbness of her lower extremities and constipation.
Crohn's is marked by transmural ulceration of the bowel wall as well as thickening of the bowel wall and adjacent mesentery. These ulcerations can lead to the formation of sinus tracts or fistulas, especially of the distal ileum. These can be identified by a branching of the barium flow or by the filling of a distal loop before a more proximal loop has opacified.. Crohn's is not usually found radiographically until ulcers have enlarged and pseudopolyps and a cobblestone appearance are seen. More advanced disease leads to extensive ulceration of the terminal ileum and the characteristic "string sign", caused by the loss of both the normal ileal features and the cobblestone pattern. Small bowel obstruction is another complication of late disease seen radiographically as the ileum becomes more stenotic.