Post-ischemic enteritis mimicking Crohn's disease with complex entero-enteric fistulization
4 affiliations
- 1Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Centre, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- 2Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Centre, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Corresponding author.
- 3Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- 4Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Mesenteric venous thrombosis is an uncommon yet potentially life-threatening cause of mesenteric ischemia with an insidious clinical course. Delayed diagnosis of venous ischemia may lead to late complications such as bowel strictures, perforation, and fistulization. These sequelae can closely mimic Crohn's disease, posing significant diagnostic and therapeutic challenges. We report the case of a 33-year-old postpartum woman who presented with acute abdominal pain and was diagnosed with subacute thrombosis of the superior mesenteric vein and portal vein confluence on contrast-enhanced CT. Initial imaging demonstrated jejunal wall thickening without signs of transmural necrosis, and the patient was managed conservatively with anticoagulation. Despite treatment, she later developed recurrent abdominal pain, bowel obstruction, perforation, and complex small bowel fistulization. Serial imaging findings were initially interpreted as fibrostenotic Crohn's disease. Endoscopic evaluation and bowel biopsies were unremarkable. Ongoing recurrent obstruction ultimately necessitated limited small bowel resection, and histopathologic findings confirmed ischemic injury, characterized by ulceration, vascular congestion, granulation tissue, and full-thickness hyalinization and necrosis. The patient unfortunately died from postoperative complications seven months after the initial presentation. This case highlights chronic ischemic enteritis as an important masquerader of Crohn's disease, particularly in patients with a history of mesenteric venous thrombosis. Complex fistulization and fibrostenotic changes are not pathognomonic for inflammatory bowel disease and may represent late sequelae of missed or patchy bowel ischemia. Careful assessment of mesenteric vasculature and collateral formation on imaging is crucial to avoid misdiagnosis, inappropriate immunosuppressive therapy, and delayed definitive management.
Related
- Atypical presentation of subclavian steal syndrome mimicking transient ischemic attack: successful endovascular management with angiographic correlation—a case report
- Complex sclerosing lesions of the breast mimicking carcinoma: diagnostic pitfalls and the decisive role of immunohistochemistry
- Subependymal Giant Cell Astrocytoma Mimicking Recurrent Ependymoma: Imaging Clues to the Diagnosis of Tuberous Sclerosis Complex
- Spontaneous fistulization of a giant pancreatic pseudocyst into the duodenum following acute pancreatitis: a case report
- A Salivary Conglomerate with a Substantial Organic Component Mimicking a Mineral Sialolith in the Mandibular-Sublingual Gland Complex of a Dog.
BibTeX
@article{faezesalahshour2026postischemic,
title = {{Post-ischemic enteritis mimicking Crohn's disease with complex entero-enteric fistulization}},
author = {Faeze Salahshour, MD and Sahar Yaghoubi, MD and Nasim Khajavirad, MD and Amir Ghasemloee, MD},
journal = {Radiology Case Reports},
year = {2026},
month = oct,
doi = {10.1016/j.radcr.2026.09.071},
url = {https://doi.org/10.1016/j.radcr.2026.09.071},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Post-ischemic enteritis mimicking Crohn's disease with complex entero-enteric fistulization
AU - Faeze Salahshour, MD
AU - Sahar Yaghoubi, MD
AU - Nasim Khajavirad, MD
AU - Amir Ghasemloee, MD
PY - 2026
DA - 2026/10/24
JO - Radiology Case Reports
DO - 10.1016/j.radcr.2026.09.071
UR - https://doi.org/10.1016/j.radcr.2026.09.071
AB - Mesenteric venous thrombosis is an uncommon yet potentially life-threatening cause of mesenteric ischemia with an insidious clinical course. Delayed diagnosis of venous ischemia may lead to late complications such as bowel strictures, perforation, and fistulization. These sequelae can closely mimic Crohn's disease, posing significant diagnostic and therapeutic challenges. We report the case of a 33-year-old postpartum woman who presented with acute abdominal pain and was diagnosed with subacute thrombosis of the superior mesenteric vein and portal vein confluence on contrast-enhanced CT. Initial imaging demonstrated jejunal wall thickening without signs of transmural necrosis, and the patient was managed conservatively with anticoagulation. Despite treatment, she later developed recurrent abdominal pain, bowel obstruction, perforation, and complex small bowel fistulization. Serial imaging findings were initially interpreted as fibrostenotic Crohn's disease. Endoscopic evaluation and bowel biopsies were unremarkable. Ongoing recurrent obstruction ultimately necessitated limited small bowel resection, and histopathologic findings confirmed ischemic injury, characterized by ulceration, vascular congestion, granulation tissue, and full-thickness hyalinization and necrosis. The patient unfortunately died from postoperative complications seven months after the initial presentation. This case highlights chronic ischemic enteritis as an important masquerader of Crohn's disease, particularly in patients with a history of mesenteric venous thrombosis. Complex fistulization and fibrostenotic changes are not pathognomonic for inflammatory bowel disease and may represent late sequelae of missed or patchy bowel ischemia. Careful assessment of mesenteric vasculature and collateral formation on imaging is crucial to avoid misdiagnosis, inappropriate immunosuppressive therapy, and delayed definitive management.
SN - 1930-0433
ER -