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Penetrating Crohn disease: does it occur in the absence of stricturing disease?
Emily S Orscheln1, Jonathan R Dillman2, Alexander J Towbin2
1Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. emily.orscheln@cchmc.org.
Insights
Penetrating complications in pediatric Crohn disease (CD) are strongly linked to significant bowel narrowing and active inflammation. These complications predominantly affect the ileum in children and adolescents.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Medical Imaging in Pediatrics
Background:
- Crohn disease (CD) is a chronic inflammatory condition affecting the gastrointestinal tract.
- Penetrating complications, such as fistulas and abscesses, are significant causes of morbidity in pediatric CD.
- Understanding the relationship between luminal narrowing and penetrating complications is crucial for effective management.
Purpose of the Study:
- To investigate the association between penetrating complications and bowel luminal narrowing/stricturing in pediatric Crohn disease.
- To characterize the imaging features of penetrating complications in relation to strictures.
- To identify specific patterns of bowel involvement in pediatric CD with penetrating complications.
Main Methods:
- Retrospective review of CT and MRI examinations in pediatric CD patients (≤18 years) with penetrating complications.
- Documentation of complication type, affected bowel segment, luminal diameter, upstream dilation, and inflammation.
- Descriptive statistical analysis of collected imaging and clinical data.
Main Results:
- 52 penetrating complications were identified in 45 pediatric CD patients.
- 98% of complications occurred with severe luminal narrowing (≤2 mm diameter).
- All penetrating complications were associated with active intestinal inflammation, predominantly in the terminal/distal ileum.
Conclusions:
- Penetrating complications in pediatric Crohn disease are highly correlated with significant luminal narrowing or stricture.
- Active intestinal inflammation is a constant feature accompanying these complications.
- The terminal and distal ileum are the most commonly affected segments.
Purpose:
To establish the relationship between penetrating complications and bowel luminal narrowing/stricturing disease in pediatric Crohn disease (CD).
Materials And Methods:
This retrospective study was IRB-approved and HIPAA compliant with waiver of informed consent. CT and MRI examinations describing intra-abdominal penetrating complications in CD patients ≤ 18 years old between January 1, 2009 and March 31, 2016 were reviewed to document: type of complication, affected bowel segment, minimum bowel luminal diameter, maximum upstream diameter, location of penetrating complication relative to luminal narrowing, length of narrowed bowel segment, and the presence of active bowel wall inflammation. Data were summarized using descriptive statistics including means, standard deviations, as well as counts and percentages.
Results:
A total of 52 penetrating complications were identified in 45 patients. Mean patient age was 15.7 ± 2.2 years (range 11-18 years) with 25/45 (56%) boys. Nearly all penetrating complications (51/52, 98%) were associated with a minimum bowel luminal diameter of ≤ 2 mm, with no visible lumen in 26/52 (50%). Mean maximum upstream diameter was 2.8 ± 0.8 cm (range 1.2-5.2 cm), and 17/52 (33%) penetrating complications were associated with > 3 cm upstream diameter. The mean ratio of maximum to minimum luminal diameter was 26.2 ± 8.8 (range 3.6-52.0). Active intestinal inflammation was associated with 100% (52/52) of penetrating complications. Nearly every penetrating complication (51/52, 98%) involved the terminal or distal ileum.
Conclusions:
Penetrating complications in pediatric CD nearly always occur in the setting of considerable luminal narrowing or stricture and active intestinal inflammation.
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