Predictive value of small bowel radiography for recurrent Crohn Disease

Small bowel radiographs of 53 patients who had remote surgery for Crohn disease were reviewed. In 10 of these, the radiographic studies could be compared with pathologic specimens from recent reoperations. The correlation of radiographic features and photographic and histopathologic alterations in these specimens was very close. Normal radiographs were found in 21 patients. In the other 32 patients, various types of inflammatory lesions were recorded. Submucosal edema was seen as broad folds in 23 patients, as irregular folds in 10 patients, and as absence of mucosal folds in nine patients. Superficial ulcerations were seen in 22 patients. Transmural lesions were seen in 14 patients but were seldom pronounced. Patients with normal postoperative small bowel radiographs had no signs of clinical recurrence, whereas 27% (4/15) of those with submucosal edema and superficial ulcerations had clinical signs of recurrence. In 87% (13/15) of patients with transmural lesions, there was clinical recurrence. Local progression could be documented in two of 20 patients. There were no instances of axial progression. Postoperative small bowel radiography seems to have useful predictive value for recurrent Crohn disease.