Diagnosis: Crohns Disease

History: 19 year-old male with epigastric abdominal pain and hematochezia.

Findings: CT demonstrates homogeneous density of thickened bowel wall with intestinal lumen surrounded by edematous mucosa. The distal jejunum and terminal ileum were involve. Intervening segments of bowel were unremarkable. Subsequent colonoscopy demonstrated nodularity within the terminal ileum. Small bowel follow through revealed delayed transit time with persistent narrowing and thickening of the distal jejunum and terminal ileum.

Ddx: Thickened small bowel folds are nonspecific and can be seen in a wide variety of condtions, including : Inflammatory bowel dieseae, other inflammatory conditions, ischemia, hemorrhage,infection (TB, celiac). neoplasm (lymphoma, carcniod, adenocarcinoma) and amyloidosis. Decreased Small Bowel transit time is possible in: Inflammatory bowel dieseae, Hypothyroidism, Diabetes, Scleroderma, Opiate use or Celiac disease.

Dxhow: Imaging and colonoscopic findings in conjunction with patient history. Biopsy demonstrated inflammatory changes.

Exam: Diffuse TTP, Soft, non-distended, +BS, No HSM, No rebound tenderness.