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Identifying Strictures

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So for this case, we're going to talk about

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strictures in Crohn's disease and how to identify

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them and what we need to talk about when we see them.

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And so this is a patient who has multiple

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segments of bowel that are hyperenhancing.

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If you look at this area here, this

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is a proximal jejunal segment.

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So when we compare it to other proximal jejunal

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segments, we see it's clearly more enhancing than

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the surrounding bowel, but it extends for quite

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a long period here up into the upper abdomen.

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As we come into the upper abdomen, we see this kind

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of transition where it goes from, you know, fairly

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normal or slightly smaller caliber to a larger caliber.

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I mean, whenever we see that transition, when

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we see a larger caliber segment, we need to

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decide, is there a stricture there?

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And if so, how do we describe that?

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And so when we look on our axial plane, we see that

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that area really is quite narrowed as it comes into

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this more proximal segment that's quite distended.

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And so this is a slam dunk case where there's

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clearly a stricture in the segment of bowel.

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And so anytime you see upstream dilation that's

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greater than three centimeters, and you see

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narrowing downstream from that, you should call

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a stricture, and you should call it confidently.

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Sometimes you'll have cases where there's

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a persistent narrowing, but you don't

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really see that upstream dilation.

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And for those cases, you should raise the

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possibility of stricture, but it's not as much of a

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clear slam dunk case, and it may not be as clinically significant

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as these cases where we clearly see upstream dilation.

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So you can call it a probable stricture if there's

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a fixed narrowing, but when we see the upstream

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dilation as we do in this case, along with the

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area of narrowing, we call it a clear stricture.

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Now these happen as a mix of acute and

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chronic processes from the Crohn's disease.

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However, oftentimes it's a marker of

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a more chronic fibrotic process.

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And so in addition to the degree of

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stricturing, we need to talk about the degree

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of inflammation that's associated with that,

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and we'll talk a little bit more about that

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in subsequent cases.

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But in this case, we have a pretty

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substantial upstream narrowing and we have

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upstream dilation and downstream narrowing.

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It's a slam dunk Crohn's stricture.

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There are other causes of strictures,

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of course, in the small ball, including

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NSAID use and radiation enteropathy.

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So strictures aren't specific for Crohn's disease,

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but there are common...an important finding on imaging

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studies and the surgeons and

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gastroenterologists really need to know when they're present.

Report

Faculty

Benjamin Spilseth, MD, MBA, FSAR

Associate Professor of Radiology, Division Director of Abdominal Radiology

University of Minnesota

Tags

Small Bowel

Non-infectious Inflammatory

MRI

Large Bowel-Colon

Idiopathic

Gastrointestinal (GI)

Crohn’s Disease

Body

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