A prominent submucosal layer of decreased attenuation was demonstrated on CT in three patients with inflammatory bowel disease. On pathologic examination this zone proved to be due to extensive submucosal fat accumulation and not active inflammation. The potential significance of this finding is discussed.

Adipose Tissue↗

PubMedDate not supplied

Computed tomography vs barium studies in the acutely symptomatic patient with Crohn disease.

Gastrointestinal contrast studies and CT performed on 43 patients with known Crohn disease with acute symptoms were retrospectively reviewed to assess the ability of each study to define the location and extent of disease. In 39 of 43 (91%) patients the contrast studies and CT agreed on the location of active disease. However, in 15 of 43 (35%) patients, contrast studies demonstrated additional areas of mucosal disease remote from the major area of activity that were not suggested by CT. In addition to demonstrating more extensive mucosal disease, contrast studies proved superior in demonstrating enteroenteric fistulae, sinus tracts, strictures, postsurgical anatomy, and relation of recurrence to anastomosis. Computed tomography proved superior in demonstrating mesenteric inflammation, abscesses, enterovesical and enterocutaneous fistulae, fistula to iliopsoas muscle and to sacrum. We conclude that in the patient with suspected abscess, enterovesical or enterocutaneous fistula, CT is the study of choice. In other clinical circumstances both CT and contrast studies should be performed since they are complementary.

Acute Disease↗

PubMedDate not supplied

Bladder involvement in Crohn disease: role of CT in detection and evaluation.

A retrospective review of 275 consecutive patients with symptomatic Crohn disease to determine the frequency and type of bladder involvement yielded 14 cases. All 14 patients had a long standing history of Crohn disease with other positive radiologic features at the time of detection of bladder involvement. Patients were categorized into two groups based on the CT findings: Group I (n = 4) had focal bladder wall thickening adjacent to an extravesical soft tissue mass and/or focal bowel wall thickening; Group II (n = 10) had fistula formation with intravesical air with associated focal bowel wall thickening and/or extravesical soft tissue mass. Bladder involvement in Crohn disease is a progressive pathological process that can result in formation of an enterovesical fistula. The patient may come to radiologic attention at any stage in the course of the disease. Computed tomography is a sensitive and noninvasive method of evaluating the bladder and can be used to identify patients in the prodromal stage who are at risk of developing enterovesical fistulae. Timely intervention may prevent frank perforation into the lumen of the bladder by an inflammatory mass.

Adult↗