Dr Souvik Chatterjee Unit V (Gen Surg) MCH, Kolkata.

INVESTIGATIONS FOR CROHNS DISEASE

DIAGNOSIS
The diagnosis of Crohns disease is made by a combination of 1) Clinical 2) Endoscopic features 3) Radiologic

ENDOSCOPIC FEATURES

1) Allows for inspection of mucosal disease, provides an opportunity for biopsy.

2) Characteristic features include aphthous ulcers, longitudinal ulcerations, skip lesions often with rectal sparing, pseudopolyps & strictures.

CAPSULE ENDOSCOPY

1) New tool.
2) Can detect subtle mucosal lesions that are not apparent on small bowel X rays.

3) Value is yet to be fully established.

SMALL BOWEL RADIOGRAPHY/ENTEROCLYSIS

1) Should be performed in all cases, best means for assessing the small bowel. 2) Characteristic features are :- skip lesions,contour defects, longitudinal &transverse ulcers, cobblestonelike mucosal pattern, strictures, thickening of haustral margin, irregular nodular defects. 3) But ileosigmoid & ileovesical fistulas are not typically demonstrated.

CT ABDOMEN

1) Routine CT is not necessary. 2) Very useful in identifying the complications. 3) Identify thickened & dilated gut loops, inflammatory masses or abscesses. 4) Demonstrate hydronephrosis due to retroperitoneal fibrosis & ureteral narrowing. 5) Most sensitive indictor for presence of enterovesical fistula.

THANK YOU.