Sonographic Assessment of Operated Crohn’s Disease

Introduction

Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with increasing prevalence worldwide. Despite advancement in medical therapy, surgery is still necessary in more than 50 % of CD patients. Gastrointestinal ultrasound (GIUS) is a noninvasive and accurate method for the evaluation of disease activity in CD, assessment of complications, and detection of postoperative recurrence (Maconi G et al. Ultraschall in Med 2018; 39: 304–317). The diagnosis of post-surgical recurrence mainly relies on the detection of bowel wall thickness (BWT) > 3 mm at the level of the anastomosis and/or the preanastomotic ileum. However, the operations used for CD may vary according to bowel involvement and complications, and some patients with multiple surgeries and segmental involvement of the small bowel undergo conservative surgery ([Fig. 1]). This pictorial essay aims to guide the GIUS assessment of postoperative CD, to recognize different kinds of anastomoses and strictureplasties.

Fig. 1 Different kind of surgeries for CD. Examples of ileocolonic resection with anisoperistaltic ileo-colic anastomosis a and isoperistaltic ileo-colonic anastomosis b and the most common conservative surgeries with Heineke-Mikuliz strictureplasty c and side-to-side strictureplasty or Michelassi strictureplasty d. In patients with ileocecal resection, the anastomosis can be found in the right iliac fossa or right flank. In patients with extensive right colonic resection or multiple ileo-colonic resections and ileo-transverse anastomosis, the anastomosis may be found in the right side of the abdomen, in the right hypochondrium or the epi-mesogastrium. In patients with ileo-sigmoid anastomosis, this may be found in lower quadrants, more frequently in the hypogastrium.

Publication History

Article published online:
24 June 2022