0:01

All right, so here's another case of

0:03

postoperative changes after

0:06

neoterminal ileum creation and right hemicolectomy.

0:10

And on these TrueFISP steady-state prepossession

0:13

images, you can see that this patient's transverse

0:15

colon appears normal, and then the ascending colon,

0:19

as you come down, you're missing a lot of colon, and

0:22

you join into what looks like ileum here at this site.

0:25

And so this is your neo

0:27

neoterminal ileum and anastomotic region. When we

0:31

look at this case on our post-contrast imaging,

0:34

you can see a fairly long segment of inflammation and

0:38

enhancement at that site, and this is a typical

0:41

site where we see recurrent Crohn's disease

0:44

and evaluation of these postoperative cases.

0:48

Certainly, you want to look at the entirety of the

0:49

bowel, since Crohn's can recur anywhere, but the

0:52

majority of the recurrences do occur right at that

0:54

anastomosis, and it can be tricky at times to evaluate.

0:58

So there's really three different

0:59

levels of appearance of this.

1:01

One is a normal appearance, where there's

1:02

no thickening, no edema, and no enhancement.

1:06

Secondarily, there's an appearance where there's just

1:09

a little bit of enhancement, and that is often seen

1:11

and it doesn't necessarily equate to a recurrence.

1:15

And then in the third case, there's

1:16

true recurrent Crohn's disease.

1:18

And in that, what we see is a

1:19

more severe level of enhancement.

1:22

And potentially other findings that we see with

1:24

Crohn's, such as enhancement surrounding the

1:27

bowel, edema, ulceration, and other secondary findings.

1:31

And so when characterizing this disease, these images,

1:35

when you see a long segment of enhancement like that,

1:37

that should be recurrent Crohn's most typically.

1:40

And so that's what we've raised the concern for.

1:43

And then we also look here; it looks like

1:44

there's probably some bowel wall edema and

1:46

other findings that make us concerned.

1:49

This is recurrent Crohn's disease.

1:51

So that's how this was interpreted.

1:52

And indeed, at the clinical

1:54

anoscopy, that was what they found.