Interactive Transcript
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All right, so here's another case of
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postoperative changes after
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neoterminal ileum creation and right hemicolectomy.
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And on these TrueFISP steady-state prepossession
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images, you can see that this patient's transverse
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colon appears normal, and then the ascending colon,
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as you come down, you're missing a lot of colon, and
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you join into what looks like ileum here at this site.
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And so this is your neo
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neoterminal ileum and anastomotic region. When we
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look at this case on our post-contrast imaging,
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you can see a fairly long segment of inflammation and
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enhancement at that site, and this is a typical
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site where we see recurrent Crohn's disease
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and evaluation of these postoperative cases.
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Certainly, you want to look at the entirety of the
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bowel, since Crohn's can recur anywhere, but the
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majority of the recurrences do occur right at that
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anastomosis, and it can be tricky at times to evaluate.
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So there's really three different
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levels of appearance of this.
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One is a normal appearance, where there's
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no thickening, no edema, and no enhancement.
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Secondarily, there's an appearance where there's just
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a little bit of enhancement, and that is often seen
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and it doesn't necessarily equate to a recurrence.
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And then in the third case, there's
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true recurrent Crohn's disease.
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And in that, what we see is a
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more severe level of enhancement.
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And potentially other findings that we see with
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Crohn's, such as enhancement surrounding the
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bowel, edema, ulceration, and other secondary findings.
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And so when characterizing this disease, these images,
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when you see a long segment of enhancement like that,
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that should be recurrent Crohn's most typically.
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And so that's what we've raised the concern for.
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And then we also look here; it looks like
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there's probably some bowel wall edema and
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other findings that make us concerned.
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This is recurrent Crohn's disease.
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So that's how this was interpreted.
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And indeed, at the clinical
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anoscopy, that was what they found.
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