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Pathological features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Macroscopically in Crohn's disease there may be a swollen, reddened and rubbery bowel with:

  • skip lesions - discontinuous sites of pathology along the gastrointestinal tract
  • cobblestone ulceration; a result of apthous ulceration progressing to oedema and nodular thickening
  • lead pipe thickening - thickened, stiff bowel
  • narrowed lumen
  • strictures
  • 'rose-thorn' narrow-mouthed ulcers which lead to fistulae
  • fistulae, often between adherent bowel and/or bladder, vagina, other abdominal organs or the abdominal wall
  • mesenteric fat covering serosa (1)
  • enlarged mesenteric nodes

Microscopically, there is:

  • non-caseating granulomas - not always present
  • transmural inflammation and lymphocyte infiltration (1)

Crohn's disease may involve any part of the bowel from the mouth to the anus:

  • the terminal ileum is involved in nearly 50% of cases
  • jejunoileitis is also seen, but most ileal inflammation usually ends abruptly at the ileocaecal junction
  • caecal and right colonic involvement is more common than lesions in the stomach and duodenum

Reference:

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