A Novel Cause of Bowel Obstruction in a Patient with Long-Standing Crohn’s Disease

Solitary fibrous tumors are rare tumors of mesenchymal origin. Although most often observed in the lung pleura, they have been reported in varied extrapleural sites. A 70-year-old male with complicated Crohn’s disease presented with 3 days of nausea, emesis, constipation, and abdominal pain. Computed Tomography (CT) demonstrated mucosal thickening of the middescending colon, consistent with fibrosing stricture. Surgical excision revealed an unusual, 5 cm mass originating in the subserosa. Histopathology of the lesion was notable for a proliferation of cells with spindle and stellate-shaped nuclei and no appreciable mitotic figures, which extended into the muscularis and submucosa. Immunohistochemistry was STAT6 nuclear positive and cytoplasmic CD34 positive, diagnostic for solitary fibrous tumor (SFT). In this case, the SFT infiltrating into the muscularis propria and subserosa caused the stricture and bowel obstruction. This illustrates that while fibrosing strictures are usually the etiology of bowel obstruction in the setting of Crohn’s disease, other rare possible causes should be considered.

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Diagnostic role of computed tomography enterography (CTE) in assessment of intra-mural and extra-intestinal CT findings in active Crohn’s disease (CD)

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00506-0 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Rasha Mostafa Mohamed Ali ◽

Mai Bahgat Ibrahim Ghonimy

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Disease Process ◽

Ct Enterography ◽

Computed Tomography Enterography ◽

Mucosal Thickening

Abstract Background Crohn’s disease (CD) is a ruinous bowel disease, which, if left uncured, leads to penetrating bowel complications. Computed tomography enterography (CTE) is nowadays accepted as a principal modality for the assessment of small bowel diseases. The aim of this study is to assess the role of CT enterography in the identification of intramural as well as extra-intestinal CT changes yielding more thorough data about the level and severity of the disease process thus planning appropriate treatment strategy. Results From March 2017 to January 2019, 50 patients in Cairo, Egypt, who had clinical manifestations of inflammatory bowel disease, were evaluated by MDCTE. CT image analysis was processed, including anatomical localization of bowel segments affection, assessment of mucosal thickening and hyper-enhancement, and extra-enteric affection. Diagnosis of Crohn’s disease (CD) was confirmed by endoscopy and histopathology; mucosal thickening was seen in 42 patients (84%), mucosal hyper-enhancement was seen in 44 patients (88%) while engorgement of vasa recta (comb’s sign) was seen in 38 patients (76%). Conclusion Although ileocolonoscopy is a proven sensitive method to detect mucosal injury and diagnose disease activity, it is limited by its maximal extent and inability to detect transmural complications as well as limited ability to assess deep bowel wall involvement. CT enterography (CTE) is a valuable technique in diagnostic evaluation of intramural and extra-intestinal involvement in Crohn’s disease (CD) during disease activity.

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Computed tomography (CT) enteroclysis in comparison to lleo-colonoscopy in patients with Crohn's disease (CD)

Gastroenterology ◽

10.1016/s0016-5085(01)80015-9 ◽

2001 ◽

Vol 120 (5) ◽

pp. A3-A3

Author(s):

C HASSAN ◽

P CERRO ◽

A ZULLO ◽

C SPINA ◽

S MORINI

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Ct Enteroclysis

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ACTIVATED INTESTINAL MUSCLE CELLS PROMOTE PREADIPOCYTE MIGRATION: A NOVEL MECHANISM OF CREEPING FAT FORMATION IN CROHN’S DISEASE

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.082 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S34-S34

Author(s):

Ren Mao ◽

Genevieve Doyon ◽

Ilyssa Gordon ◽

Jiannan Li ◽

Sinan Lin ◽

...

Keyword(s):

Extracellular Matrix ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Ex Vivo ◽

Muscularis Propria ◽

Dominant Factor ◽

Stricture Formation ◽

Intestinal Tissue ◽

Mesenteric Fat

Abstract Background and Aims Creeping fat, the wrapping of mesenteric fat around the bowel wall, is a typical feature of Crohn’s disease, and is associated with stricture formation and bowel obstruction. How creeping fat forms is unknown, and we interrogated potential mechanisms using novel intestinal tissue and cell interaction systems. Methods Tissues from normal, ulcerative colitis, non-strictured and strictured Crohn’s disease intestinal specimens were obtained. Fresh and decellularized tissue, mesenteric fat explants, primary human adipocytes, pre-adipocytes, muscularis propria cells, and native extracellular matrix were used in multiple ex vivo and in vitro systems involving cell growth, differentiation and migration, proteomics, and integrin expression. Results Crohn’s disease muscularis propria cells produced an extracellular matrix scaffold which is in direct spatial and functional contact with the immediately overlaid creeping fat. The scaffold contained multiple proteins, but only fibronectin production was singularly upregulated by TGF-b1. The muscle cell-derived matrix triggered migration of pre-adipocytes out of mesenteric fat, fibronectin being the dominant factor responsible for their migration. Blockade of α5β1 on the pre-adipocyte surface inhibited their migration out of mesenteric fat and on 3D decellularized intestinal tissue extracellular matrix. Conclusion Crohn’s disease creeping fat appears to result from the migration of pre-adipocytes out of mesenteric fat and differentiation into adipocytes in response to an increased production of fibronectin by activated muscularis propria cells. These new mechanistic insights may lead to novel approaches for prevention of creeping fat-associated stricture formation.

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Musculoskeletal Complications of Crohn's Disease: The Role of Computed Tomography in Diagnosis and Patient Management

Orthopedics ◽

10.3928/0147-7447-20001101-17 ◽

2000 ◽

Vol 23 (11) ◽

pp. 1181-1185

Author(s):

Howard I Brenner ◽

Elliot K Fishman ◽

Mary L Harris ◽

Theodore M Bayless

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Patient Management

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Low-Dose Computed Tomography for the Optimization of Radiation Dose Exposure in Patients with Crohn’s Disease

Gastroenterology Research and Practice ◽

10.1155/2018/1768716 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Richard G. Kavanagh ◽

John O’Grady ◽

Brian W. Carey ◽

Patrick D. McLaughlin ◽

Siobhan B. O’Neill ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Image Quality ◽

Crohn's Disease ◽

Radiation Dose ◽

Ionizing Radiation ◽

Low Dose ◽

Radiation Doses ◽

Radiation Dose Exposure ◽

Ct Technology

Magnetic resonance imaging (MRI) is the mainstay method for the radiological imaging of the small bowel in patients with inflammatory bowel disease without the use of ionizing radiation. There are circumstances where imaging using ionizing radiation is required, particularly in the acute setting. This usually takes the form of computed tomography (CT). There has been a significant increase in the utilization of computed tomography (CT) for patients with Crohn’s disease as patients are frequently diagnosed at a relatively young age and require repeated imaging. Between seven and eleven percent of patients with IBD are exposed to high cumulative effective radiation doses (CEDs) (>35–75 mSv), mostly patients with Crohn’s disease (Newnham E 2007, Levi Z 2009, Hou JK 2014, Estay C 2015). This is primarily due to the more widespread and repeated use of CT, which accounts for 77% of radiation dose exposure amongst patients with Crohn’s disease (Desmond et al., 2008). Reports of the projected cancer risks from the increasing CT use (Berrington et al., 2007) have led to increased patient awareness regarding the potential health risks from ionizing radiation (Coakley et al., 2011). Our responsibilities as physicians caring for these patients include education regarding radiation risk and, when an investigation that utilizes ionizing radiation is required, to keep radiation doses as low as reasonably achievable: the “ALARA” principle. Recent advances in CT technology have facilitated substantial radiation dose reductions in many clinical settings, and several studies have demonstrated significantly decreased radiation doses in Crohn’s disease patients while maintaining diagnostic image quality. However, there is a balance to be struck between reducing radiation exposure and maintaining satisfactory image quality; if radiation dose is reduced excessively, the resulting CT images can be of poor quality and may be nondiagnostic. In this paper, we summarize the available evidence related to imaging of Crohn’s disease, radiation exposure, and risk, and we report recent advances in low-dose CT technology that have particular relevance.

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