DDX of inflammatory bowel disease

Approach to the DDX of inflammatory bowel disease:

  • Crohn’s disease
    —- Transmural inflammation of bowel
    —- Involves any part of gastrointestinal tract in a non-contiguous manner (skip lesions) but classically involves small bowel
    —- Complications include small bowel strictures and penetrating fistula which can lead to abscess
  • Ulcerative colitis
    —- Mucosal and submucosal inflammation of bowel
    —- Involves colon in a contiguous manner from the rectum retrograde in the colon, may rarely involve terminal ileum
    —- Complications include loss of haustral markings (lead pipe sign), colonic shortening and narrowing
  • Lymphoid hyperplasia is a normal finding seen on a small bowel follow through exam and should not be confused with early inflammatory changes from inflammatory bowel disease