Crohn´s Disease
Crohn´s Disease

Video Endoscopic Sequence 1 of 28.

Crohn´s Disease

(Regional Enteritis, Granulomatous Colitis).

This sequence display severe endoscopic lesions.

A 42 year-old Salvadorian woman, that has been living in The United States of America for more than 20 years. The patient presented with weigh loss of 22 pounds, abdominal pain and diarrhea during two years.

his lesions display ulcerations and retraction of the sigmoid mucosa. Causing some difficulties when advancing with the endoscope forward. After some maneuvers the stenosis was overcome. A second colonoscopy was performed shortly after some treatment. In that colonoscopy we were able to find that the terminal ileum was affected.

Crohn´s Disease

For more endoscopic details download the video clips by clicking on the endoscopic images, wait to be downloaded complete then press Alt and Enter; thus you can observe the video in full screen.

All endoscopic images shown in this Atlas contain
video clips. 

 

Image and Video Clip of Crohn´s Disease.

Video Endoscopic Sequence 2 of 28.

Image and Video Clip of Crohn´s Disease.

Another view of the lesion describes before. Some ulcers were found in the sigmoid colon. Many lesions were found in the entire colon, with severe inflammation, edema, fibrosis, ulcers and nodules. Large and deep, penetrating ulcers surrounded by areas of normal appearing mucosa were also found.

 

 

 

 

 

Video Colonoscopy of Crohn´s Disease.

Video Endoscopic Sequence 3 of 28.

Video Colonoscopy of Crohn´s Disease.

Nodular stenosis due to Crohn's disease. The transverse colon has two nodular and ulcerated stenosis. However, this stenosis was overcome by passing the colonoscope to the next lesion.

The severity of the diseases varies widely between individuals. Some suffer only mild symptoms, but others have severe and disabling symptoms. Some have a gradual onset of symptoms, some develop them suddenly. About half of patients have mild symptoms, the other half suffer frequent flare-ups.

Pathophysiology: The exact cause of Crohn disease remains unknown. Current theories implicate the role of genetic, microbial, immunologic, environmental, dietary, vascular, and even psychosocial factors as potential causative agents. It has been suggested that patients have an inherited susceptibility for an aberrant immunologic response to one or more of these provoking factors.

 

 

 

 

Video Colonoscopy of Crohn´s Disease.

Video Endoscopic Sequence 4 of 28.

Video Colonoscopy of Crohn´s Disease.

A close up of the first nodular stenosis of the transverse colon.

This is Crohn's disease affecting part or all of the colon. This form comprises about 20% of all cases of CD. Various patterns are seen. In about half of these cases CD lesions may be seen throughout one continuous subsegment of the colon. In another quarter, skip areas are seen between multiple diseased areas. In the remaining quarter, the entire colon is involved, with no skip areas.

 

 

 

 

Video Colonoscopy of Crohn´s Disease

Video Endoscopic Sequence 5 of 28.

Video Colonoscopy of Crohn´s Disease.

The video clip displays passing of the colonoscope through to the first nodular stenosis, displaying a second transverse colon lesion which is nodular and ulcerated also.

Microscopically, the initial lesion starts as a focal inflammatory infiltrate around the crypts, followed by ulceration of superficial mucosa. Later, inflammatory cells invade deep layers and, in that process, begin to organize into noncaseating granulomas. The granulomas extend through all layers of the intestinal wall and into the mesentery and the regional lymph nodes. Although granuloma formation is pathognomonic of Crohn disease, absence does not exclude the diagnosis.

 

Video Colonoscopy of Crohn´s Disease.

Video Endoscopic Sequence 6 of 28.

Video Colonoscopy of Crohn´s Disease.

This lesion belong to the second stenosis of the transverse colon, which is nodular and ulcerated. The orifice is very small and impossible to pass through. We performed a second colonoscopy, after 7 days of treatment. See the sequence below, where this stenosis was overcome and the terminal ileum was visualized.

 

Image and Video Clip of Crohn´s Disease.

Video Endoscopic Sequence 7 of 28.

Image and Video Clip of Crohn´s Disease.

Transverse colon, high grade nodular stenosis The biopsies were taken from different ulcerated nodules. 

Transmural inflammation results in thickening of the bowel wall and narrowing of the lumen. As the disease progresses, it is complicated by obstruction, fistulization, abscess formation, adhesions, and malabsorption.

 

Endoscopic image of Crohn´s Disease.

Video Endoscopic Sequence 8 of 28.

Endoscopic image of Crohn´s Disease.

The rectum seen in retroflexed view. A polyp is observed
We were not sure if this polyp was caused by the Crohn’s
disease itself. However, we observed after a short time
of treatment, administered with steroids and antibiotics,
we observed that this lesion appeared as a hypertrophic
papillae. See video endoscopic sequence 27.


Crohn´s Disease after short-time treatment.

Video Endoscopic Sequence 9 of 28.

Crohn´s Disease after short-time treatment.

Prominent rectum vessels were found, giving a congestive
appearance after a short-time treatment with steroids.

 

Crohn´s Disease after short-time treatment.

Video Endoscopic Sequence 10 of 28.

Crohn´s Disease after short-time treatment.

Some polyps are founded into the sigmoid colon,
not seen by the previous colonoscopy. It may
be due to a better colon preparation.

“ Pseudo polyps.” 

 

Crohn´s Disease, after a short-time treatment.

Video Endoscopic Sequence 11 of 28.

Crohn´s Disease, after a short-time treatment.

The video clip displays the difficulties in advancing the
colonoscope throughout recto-sigmoid junction due to
the narrowing caused by the ulcer.

 

Crohn´s Disease

Video Endoscopic Sequence 12 of 28.

Upgrading information.

Long and serpiginous ulcers and nodules of sigmoid.

The patient was hospitalized and received 50 mg. oral prednisone daily, 500 mg IV ciprofloxacin every 8 Hrs.and 500 mg IV metronidazole every 8 Hrs. Its is Important to remark that the therapeutical effectiveness of these medications are seen in the new colonoscopy, performed 7 days after the initiating the treatment. We could overcome the nodular stenosis previously described, by finding the ileocecal valve destroyed, by the disease; after passing throughout the valve, we could exam around 30 cm of the terminal ileum finding an active disease.
The colon was found to measure 120 CM. long.

 

 

 

 

Crohn´s Disease

Video Endoscopic Sequence 13 of 28.

Ulcers and nodules of the sigmoid and descending colon.

Though any portion of the gastrointestinal tract may be
involved with Crohn's disease, the small intestine--and the
terminal ileum in particular--is most likely to be involved.

 

Crohn´s Disease

Video Endoscopic Sequence 14 of 28.

Video Colonoscopy of Crohn´s Disease.

The video clip displays a colonoscopy of the transverse
colon, displaying a narrowing with nodules and ulcers.

 

Crohn´s Disease

Video Endoscopic Sequence 15 of 28.

Video Colonoscopy of Crohn´s Disease.

The image and the video clip display a lesion caused 
by this disease. Theses are nodularity, deformed and
stenosis with ulcers.

 

 

Crohn´s Disease

Video Endoscopic Sequence 16 of 28.

Video Colonoscopy of Crohn´s Disease.

The cecum and the ileocecal valve are destroyed due to
nodules and ulcers. 

 

Crohn´s Disease

Video Endoscopic Sequence 17 of 28.

The appendiceal orifice is observed. There are some tiny
rounded ulcers like the aphthous ulces or hyperplasic
follicles.

 

Crohn´s Disease

Video Endoscopic Sequence 18 of 28.

Video Colonoscopy of Crohn´s Disease.

The ileocecal valve is destroyed by the disease itself,
this valve is nodular and ulcerated.

 

Crohn´s Disease

Video Endoscopic Sequence 19 of 28.

Terminal ileum.

The image and video of this sequence reveals the passage
of the colonoscope through the ileocecal valve to terminal
ileum.

You must see the video by clicking on the image.

 

 

 

 

Video Colonoscopy of Crohn´s Disease.

Video Endoscopic Sequence 20 of 28.

Video Colonoscopy of Crohn´s Disease.

Terminal ileum. Irregular ulceration, erithema and nodules are appreciated.

When we look at the spectrum of Crohns disease, probablyone-half to two-thirds of the patients have the disease, involving thelast portion of the small intestine and the first portion of the colonMaybe another quarter of patients have disease only in the small intestine,and another quarter only in the large intestine. So thedistribution of Crohns disease in the intestinal track is importantbecause we now have different medical therapies that can actuallybe targeted to sites along the intestine both the anti-inflammatorytherapies, called the five ASA agents and new steroid treatmentsare actually targeted to the ileum and the first portion of the colon.So the location of the disease is very important, to begin with.

 

 

 

 

Crohn´s Disease

Video Endoscopic Sequence 21 of 28.

Terminal ileum “ileitis”.

At one time, Crohn´s Disease was thought to affect only the
ileum, and for this reason the name "ileitis" was at one
time synonymous with CD but now simply refers to Crohn's
disease of the ileum.

 

Crohn´s Disease

Video Endoscopic Sequence 22 of 28.

Video Colonoscopy of Crohn´s Disease.

Junction of the cecum with the ascending colon.
The condition occurs in both sexes and among all age
groups, although it most frequently begins in young people
Jewish people are at increased risk of developing Crohn's,
while African Americans are at decreased risk, which
indicates the genetic link in this disease.

 

Crohn´s Disease

Video Endoscopic Sequence 23 of 28.

The video clip display a long segment of the
colonoscopy displaying from the appendiceal orifice
to the sigmoid.

You should see the video clip, which is quite long and
takes some time to download.

 

Crohn´s Disease

Video Endoscopic Sequence 24 of 28.

Video Colonoscopy of Crohn´s Disease.

Crohn’s is a serious inflammatory disease of the
gastrointestinal tract that causes diarrhea, abdominal
cramps, fever and rectal bleeding. The cause of Crohn’s
disease is unknown.

 

Crohn´s Disease

Video Endoscopic Sequence 25 of 28.

Video Colonoscopy of Crohn´s Disease.

(Serpiginous linear ulcers) Inflammatory bowel disease
("cobblestone" like mucosa).

 

Crohn´s Disease

Video Endoscopic Sequence 26 of 28.

Anus.

 

Crohn´s Disease

Video Endoscopic Sequence 27 of 28.

Rectum Retroflexed Image.

 

Crohn´s Disease

Video Endoscopic Sequence 28 of 28.

Gastric Crohn´s Disease.

Antrum: gastric wall thickening resembles chronic
erosions.
Crohns disease is an inflammation of the digestive trackthat
can affect any portion of the digestive track.

 

Crohn´s Disease of the ileocecal valve and terminal Ileum

Video Endoscopic Sequence 1 of 5.

Crohn´s Disease of the ileocecal valve and terminal Ileum

This 73 year-old male, has been suffering of fever,
abdominal pain, anorexia and anemia, his hemoglobin
level was 8.7 g/dL.

 

 

 

 

Video Colonoscopy of Crohn´s Disease.

Video Endoscopic Sequence 2 of 5.

Video Colonoscopy of Crohn´s Disease.

Colonoscopic examination revealed deformed ileocecal
valve with ulcerations and stenotic areas.

 

Crohn´s Disease of the ileocecal valve and terminal Ileum

Video Endoscopic Sequence 3 of 5.

General clinical features of Crohn disease are fever,
abdominal pain, diarrhea, and fatigability. Weight loss is
also associated. Diarrhea and pain are the most common
symptoms of colonic involvement. Rectal bleeding is less
common. Anorectal complications are fistulas, fissures, and
perirectal abscess. Involvement of the small intestine can
lead to steady and localized right lower quadrant pain;
ileitis is fairly common. Physical examination may reveal
right lower quadrant tenderness with an associated fullness
or mass. Patients may also have mild anemia, leukocytosis,
and an increased erythrocyte sedimentation rate.

 

Crohn´s Disease of the ileocecal valve and terminal Ileum

Video Endoscopic Sequence 4 of 5.

Intestinal obstruction is a frequent complication. In the
initial stage, obstruction from edema and inflammation
commonly in the ileum are reversible. As disease
progresses, fibrosis develops, leading to decreasing
diarrhea and more constipation and intractable obstruction
from fixed luminal narrowing.

 

Crohn´s Disease of the ileocecal valve and terminal Ileum

Video Endoscopic Sequence 5 of 5.

Fistula formation is common and can cause indolent abscess, malabsorption, cutaneous fistula, persistent urinary tract infection, or pneumaturia. Although uncommon, free intestinal perforation can occur as a result of transmural involvement of the disease.

Extraintestinal manifestation of Crohn disease includes oral aphthous ulcer, erythema nodosum, osteomalacia, and anemia due to chronic malabsorption; osteonecrosis due to chronic steroid therapy; gallstone formation due to ileal involvement of disease leading to poor bile salt reabsorption; oxalate kidney stones due to colonic disease; pancreatitis due to sulfasalazine, mesalamine, azathioprine, or 6-mercaptopurine therapy; bacteria overgrowth due to surgical resection; and miscellaneous manifestations such as amyloidosis, thromboembolic complications, hepatobiliary disease, and primary sclerosing cholangitis.

Terminal ileum  involvement

Commonly

Seldom

Rectum involvement

Seldom

Usually

Involvement around the anus

Common

Seldom

Bile duct involvement

No increase in rate of primary sclerosisng cholangitis

Higher rate

Distribution of Disease

Patchy areas of inflammation (Skip lesions)

Continuous area of inflammation

Endoscopy

Deep geographic and serpiginous (snake-like) ulcers

Continuous ulcer

Depth of inflammation

May be transmural, deep into tissues

Shallow, mucosal

Fistula

Common

Seldom

Stenosis

Common

Seldom

Autoimmune disease

Widely regarded as an autoimmune disease

No consensus

Cytokine response

Associated with Th1T helper cell

Vaguely associated with Th2

Granulomas on biopsy

Can have granulomas

Granulomas uncommon

Surgical cure

Often returns following removal of affected part

Usually cured by removal of colon

Smoking

Higher risk for smokers

Lower risk for smokers

 

Crohn´s Colitis

Video Endoscopic Sequence 1 of 3.

Crohn´s Colitis

Multiple small aphthous erosions (1 to 2 mm) with erythematous rims.

This 36 year-old male, Swedish it had arrived at El
Salvador by vacations, has antecedent of long evolution to
suffer from abdominal pain, diarrhea with occasions with
mucus and some periods of fever.

 

Colonoscopy of Crohn´s Colitis

Video Endoscopic Sequence 2 of 3.

Colonoscopy of Crohn´s Colitis

Terminal Ileum shows tiny red spot with scanty fibrinoid areas.

 

Colonoscopy of Crohn´s Colitis

Video Endoscopic Sequence 3 of 3.

All the length of the colon shows multiple small aphthous erosions.

 

Enfermedad de Crohn

Video Endoscopic Sequence 1 of 17.

Crohn's disease and diverticular disease

We report the case of a 68 year-old, male of who presented abdominal pain, fever and enterorrhagia.

A colonoscopy has multiple diverticulae in the right colon and ulcerated lesions and a pseudotumor in the cecum.

Diverticulitis and Crohn's disease affecting the colon occur at similar sites in older individuals, and in combination are said to carry a worse prognosis than either disease in isolation. It is possible that diverticulitis may initiate inflammatory changes which resemble Crohn's disease histologically, but do not carry the clinical implications of chronic inflammatory bowel disease.

 

 

 

 

Crohn's disease

Video Endoscopic Sequence 2 of 17.

Crohn's disease

Nodules and ulceration of the ascending colon, there purulent discharge. The first impression of this image is diverticulitis.


 

 

 

Crohn's disease

Video Endoscopic Sequence 3 of 17.

An ulcerated lesion in the ascending colon is observed.

Various ulcerations with nodules through the right colon near the cecum were found.

 

 

 

 

 

Crohn's disease

Video Endoscopic Sequence 4 of 17.

In the ileocecal valve is observed a pseudotumoral mass

 

 

 

 

Crohn's disease

Video Endoscopic Sequence 5 of 17.

Appendix hole is observed above this there is an ulcer, bordering with the pseudo mass.

 

 

Crohn's disease

Video Endoscopic Sequence 6 of 17.

In the cecum there are several lesions of different morphologies

 

 

 

Crohn's disease

Video Endoscopic Sequence 7 of 17.

Cecum: Ulceration up of hole of the appendix

 

 

Crohn's disease

Video Endoscopic Sequence 8 of 17.

Some biopsies are taking, histopathology which are shown below.

 

 

Crohn's disease

Video Endoscopic Sequence 9 of 17.

Crohn's disease

The pseudotumor which comes from the ileocecal valve

Crohn's disease

Video Endoscopic Sequence 10 of 17.

Ulceration of folds of the ascending colon in the border with the cecum, watching some diverticula and the pseudotumor.

 

 

Crohn's disease

Video Endoscopic Sequence 11 of 17.

Ulcerated and irregular fold

Crohn's disease

Video Endoscopic Sequence 12 of 17.

Crohn's disease

View of mucosal granuloma

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Crohn's disease

Video Endoscopic Sequence 13 of 17.

Crohn's disease

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Crohn's disease

Video Endoscopic Sequence 14 of 17.

Crohn's disease

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Crohn's disease

Video Endoscopic Sequence 15 of 17.

Crohn's disease

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Crohn's disease

Video Endoscopic Sequence 16 of 17.

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Crohn's disease

Video Endoscopic Sequence 17 of 17.

Crohn's disease

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