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This 45 year-old female patient presented with fevers and two weeks of obstipation. There was a past history of Crohn’s disease, multiple laparotomies, enterocutaneous and enterovaginal fistulas.
The CT shows a fistula from a loop of small bowel to the skin. None of the administered oral contrast passed into bowel distal to the fistula.
Crohn’s disease is an idiopathic inflammatory bowel disease with discontinuous and asymmetric involvement of the entire gastrointestinal tract. It is characterised by transmural non-caseating granulomatous inflammation. The usual onset is between 15 and 30 years, with no sex predominance. Presentation is with abdominal pain, fever, weight-loss, anaemia, perianal abscess or fistula, or malabsorption. There is involvement of the small bowel in 80% of cases, which manifests as fold thickening, aphthous ulcers, extensive mucosal ulceration, and fistulation to skin, bowel, vagina or bladder.
Reference: Dähnert W. Radiology Review Manual, 5th edition, Lippincott, Williams & Wilkins, 2003.
Credit: Dr Laughlin Dawes

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