Crohn’s Disease

barium small bowel series showing cobblestoning
Crohn’s disease is an idiopathic inflammatory bowel disease with discontinuous and asymmetric involvement of the entire gastrointestinal tract. It is characterised by transmural non-caseating granulomatous inflammation. The usual onset is between 15 and 30 years, with no sex predominance. Presentation is with abdominal pain, fever, weight-loss, anaemia, perianal abscess or fistula, or malabsorption. There is involvement of the small bowel in 80% of cases, which manifests as fold thickening, aphthous ulcers, or extensive mucosal ulceration. In this case there is cobblestoning which is due to serpiginous longitudinal and transverse ulcers separated by areas of oedema. There is also separation of small bowel loops due to bowel wall thickening. Deep mucosal ulcers are seen, sometimes referred to as rose-thorn ulcers.

Reference: Dähnert W. Radiology Review Manual, 5th edition, Lippincott, Williams & Wilkins, 2003.

Credit: Dr Laughlin Dawes