Images in Clinical Medicine

Fistulizing Crohn's Disease

William Sanchez, M.D., and Edward V. Loftus, M.D.

N Engl J Med 2002; 347:416August 8, 2002

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Figure 1 A 54-year-old man with a long history of Crohn's disease presented with abdominal pain, low-grade fevers, fatigue, and pneumaturia. Several enterocutaneous fistulas as well as worsening of perianal disease had recently developed. Computed tomography of the abdomen revealed multiple thickened loops of small bowel indicative of chronic active Crohn's disease (curved arrows in Panel A). A large abdominal-wall abscess with air–fluid levels developed as a result of the enterocutaneous fistulas (straight arrow in Panel A), and an obstructing staghorn calculus of the left kidney developed as a complication of chronic urinary tract infection (arrow in Panel B).

William Sanchez, M.D.
Edward V. Loftus, M.D.
Mayo Clinic, Rochester, MN 55905