Intestinal stricture in Crohn's disease

Abstract

Crohn's disease (CD) is a disease with chronic inflammation of unknown etiology involving any part of the gastrointestinal tract. The incidence and prevalence of CD are increasing recently in Asia. Half of the CD patients will have intestinal complications, such as strictures or fistulas, within 20 years after diagnosis. Twenty-five percentage of CD patients have had at least one small bowel stricture and 10% have had at least one colonic stricture and lead to significant complications. Most of these patients will require at least one surgery during their lifetime. Early diagnosis and evaluation with adequate managements for the patients can prevent disability and mortality of these patient. Here, we reviewed the current incidence of CD with stricture, the etiology of stricture, and how to diagnose and manage the stricture.

Keywords: Constriction, pathologic; Crohn disease; Diagnosis; Disease management; Intestines.

Fig. 1

A 33-year-old woman with CD who had active inflammation with stenosis. (A) An axial T2-weighted image and (B) an axial post-contrast T1-weighted image show abnormal wall-thickening, increased enhancement, and adjacent fat-stranding of transverse and descending colon (arrows), suggestive of active inflammation. There is intestinal stenosis with dilated proximal colon (^*).

Fig. 2

A 57-year-old woman with CD who had fibrosis with stricture. (A) A coronal T2-weighted image shows an abnormal segment of the distal ileum (arrows) with wall-thickening and luminal narrowing, with relative low signal and minimal inflammatory changes, suggestive of fibrosis. There is stricture with dilated proximal intestine (^*). (B) A coronal post-contrast T1-weighted image shows another involved ileal segment at the left lower abdomen (arrow), with dilated proximal intestine (^*). The patient underwent an operation and fibrotic changes were confirmed.