SOME INTERESTING AND UNUSUAL MANIFESTATIONS OF CROHN'S DISEASE ("REGIONAL ENTERITIS") OF THE STOMACH, DUODENUM AND SMALL INTESTINE

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Abstract
A group of unusual and interesting manifestations of Crohn's disease is discussed and illustrated. The importance of recognizing and properly evaluating these findings is emphasized, particularly in patients below the age of 40 years who have not had a previous abdominal operation. Marked dilatation and stasis of luminal contents of the small intestine in patients with relatively mild symptoms or a long history of mild abdominal symptoms should imply that regional enteritis is a likely cause for the symptomatology of small intestinal obstruction in young patients who have not had previous abdominal operations. Some of the described roentgenologic findings are either diagnostic or highly suggestive of Crohn's disease, even when seen in such uncommon locations as gastric antrum, duodenum, and proximal jejunum. Involvement of the antrum, pylorus, and proximal part of the duodenum in continuity produces a "pseudo post-Billroth I" appearance which is highly suggestive of granulomatous disease when seen in patients without a previous abdominal operation. Localized forms of Crohn's disease can produce partial closed-loop types of obstruction, whereas blind-loop obstructions and severe malabsorption problems can occur when the disease causes a high grade obstruction of the distal portion of the small intestine associated with a duodenocolic fistula. "Pseudodiverticula" due to multiple crypts and the occasional unreliability of the "string sign" as shown following the ingestion of barium sulfate are discussed.

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