Ischemic Colitis and Crohn's disease: Differential diagnosis and follow-up

Purpose: To discuss differential diagnosis of M.Crohn and strategy of follow-up of patients with angioplasty of intestinal arteries.

Methods: Two patients with suspected M.Crohn were reevaluated with color coded duplex sonography (CCDS: Siemens-Sequoia, GE Logiq9). Follow-up after intervention was done every 6 months.

Results: Case 1 (60 year old female): Intermittend abdominal pain and weight loss. Biopsies in a university hospital were suggestive for M. Crohn. Treatment with steroids was without effect. CCDS showed a short occlusion of the superior mesenteric artery (SMA) 2cm distal of its origin. Immediately after dilatation complete relieve of pain. Reoccurrence of pain 1 year, 7 years and 9 years later. CCDS showed flow elevation of 300 and 400cm/s according to a 70 to 90% stenosis in the stent that could be dilated without problems.

Case 2 (38 year old female): “Known“ M.Crohn since 2 years. Stenosis of bowel segments. CCDS showed an occlusion of the celiac trunc and a high grade stenoses of the SMA with a dampened signal amplitude of the splenic and hepatic artery. After dilatation of the stenotic colon segment and stent assisted angiogplasty relieve of complaints. Reevaluation of the histology showed ischaemic ulcerations.

Conclusions: Ischemic strictures of the bowel could be misinterpreted as colitis or as M.Crohn. Especially in cases with atypical clinical symptoms CCDS and a careful reevaluation of the histology should be done.

After stent assisted angioplasty of intestinal arteries a careful follow-up by CCDS is essential to depict restenosis early enough.