Computed tomography of Crohn’s disease: The role of three dimensional technique

Figure 5 Fistulas and sinus tracts related to Crohn’s disease. A: Thirty-nine-year-old male with Crohn’s disease. Coronal image demonstrates several thick-walled, inflamed loops of small bowel tethered and matted together in the right lower abdomen, with ectopic gas (solid arrow), fluid, and phlegmonous change at the center of this collection of bowel loops. While discrete fistulous tracts could not be visualized, this constellation of findings is highly suggestive of complex fistulizing Crohn’s disease. A gallstone (dashed arrow) is incidentally visualized in the gallbladder, a commonly associated finding in Crohn’s disease (A1). Image of the bony pelvis demonstrates bilateral narrowing, sclerosis, and partial ankylosis of the sacroiliac joints (A2); B: Sixty-nine-year-old male with Crohn’s disease. Coronal volume rendered (VR) image demonstrates several thickened, inflamed bowel loops in the mid and left abdomen with mucosal hyperemia and adjacent vasa recta engorgement. A clear enhancing fistulous tract (arrow) is identified connecting adjacent tethered bowel loops; C: Twenty-four-year-old male with Crohn’s disease. Sagittal contrast-enhanced image demonstrates clumping (arrow) and matting of two immediately adjacent, inflamed loops of ileum and sigmoid colon. This appearance persisted on follow-up examination, and was highly concerning for an enterocolonic fistula; D: Twenty-eight-year-old female with Crohn’s disease. Coronal volume rendered image demonstrates an enteroenteric fistulae (arrow) connecting adjacent loops of small bowel; E: Twenty-six-year-old female with Crohn’s disease. Coronal multiplanar reformatted image demonstrates multiple loops of bowel tethered together and matted in the central abdomen. Especially given the linear gas (arrow) at the center of these bowel loops, this appearance is strongly suggestive of multiple enteroenteric and enterocolic fistulae.