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Case of the Week 370




What's the most likely diagnosis?

  • 42 year-old with crampy right lower quadrant pain



Small Bowel Study-Close-up Right Lower Quadrant

  1. Carcinoma of the ileum
  2. Lymphogranuloma venereum
  3. Crohn's Disease
  4. Retroperitoneal fibrosis
  5. Ulcerative colitis

Additional Image - Small Bowel Study-Same finding, different patient

 

Additional Image

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Small Bowel Study-Same finding, different patient

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Answer:

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3. Crohn's Disease - String Sign

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More (Click Discussion Tab)


String Sign - Crohn's Disease

General Considerations

  • Finding seen on contrast studies using primarily barium
  • Originally described in the terminal ileum in Crohn’s disease and that is its most common usage
  • Initially, it is caused by severe spasm secondary to irritability of the loop producing the appearance of a frayed cotton string
  • At first, edema and spasm narrow the loop but the narrowing is at least partially distensible
  • Eventually the wall of the ileum may become fibrotic and the lumen fixed in diameter

    More ...


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