Abdominal Radiology

, Volume 43, Issue 7, pp 1583–1589 | Cite as

Penetrating Crohn disease: does it occur in the absence of stricturing disease?

  • Emily S. OrschelnEmail author
  • Jonathan R. Dillman
  • Alexander J. Towbin
  • Lee A. Denson
  • Andrew T. Trout



To establish the relationship between penetrating complications and bowel luminal narrowing/stricturing disease in pediatric Crohn disease (CD).

Materials and methods

This retrospective study was IRB-approved and HIPAA compliant with waiver of informed consent. CT and MRI examinations describing intra-abdominal penetrating complications in CD patients ≤ 18 years old between January 1, 2009 and March 31, 2016 were reviewed to document: type of complication, affected bowel segment, minimum bowel luminal diameter, maximum upstream diameter, location of penetrating complication relative to luminal narrowing, length of narrowed bowel segment, and the presence of active bowel wall inflammation. Data were summarized using descriptive statistics including means, standard deviations, as well as counts and percentages.


A total of 52 penetrating complications were identified in 45 patients. Mean patient age was 15.7 ± 2.2 years (range 11–18 years) with 25/45 (56%) boys. Nearly all penetrating complications (51/52, 98%) were associated with a minimum bowel luminal diameter of ≤ 2 mm, with no visible lumen in 26/52 (50%). Mean maximum upstream diameter was 2.8 ± 0.8 cm (range 1.2–5.2 cm), and 17/52 (33%) penetrating complications were associated with > 3 cm upstream diameter. The mean ratio of maximum to minimum luminal diameter was 26.2 ± 8.8 (range 3.6–52.0). Active intestinal inflammation was associated with 100% (52/52) of penetrating complications. Nearly every penetrating complication (51/52, 98%) involved the terminal or distal ileum.


Penetrating complications in pediatric CD nearly always occur in the setting of considerable luminal narrowing or stricture and active intestinal inflammation.


Crohn disease Inflammatory bowel disease Gastrointestinal Pediatric 


Compliance with ethical standards

Conflict of interest

Dr. Jonathan Dillman receives IBD-related research funding from Siemens Ultrasound and Bracco Diagnostics, but none related to this project. Dr. Emily Orscheln declares no conflict of interest. Dr. Alexander Towbin declares no conflict of interest. Dr. Lee Denson declares no conflict of interest. Dr. Andrew Trout declares no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent of human participants is not required and was waived. This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Day AS, Ledder O, Leach ST, Lemberg DA (2012) Crohn’s and colitis in children and adolescents. World J Gastroenterol 18(41):5862–5869.  10.3748/wjg.v18.i41.5862 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Mamula P, Markowitz JE, Baldassano RN (2003) Inflammatory bowel disease in early childhood and adolescence: special considerations. Gastroenterol Clin N Am 32(3):967–995CrossRefGoogle Scholar
  3. 3.
    Kugathasan S, Denson LA, Walters TD, et al. (2017) Prediction of complicated disease course for children newly diagnosed with Crohn’s disease: a multicentre inception cohort study. Lancet 389(10080):1710–1718.  10.1016/S0140-6736(17)30317-3 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Benchimol EI, Fortinsky KJ, Gozdyra P, et al. (2011) Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 17(1):423–439.  10.1002/ibd.21349 CrossRefPubMedGoogle Scholar
  5. 5.
    Cleynen I, Boucher G, Jostins L, Schumm LP, et al. (2016) Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes: a genetic association study. Lancet 387(10014):156–167.  10.1016/S0140-6736(15)00465-1 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Duricova D, Burisch J, Jess T, et al. (2014) Age-related differences in presentation and course of inflammatory bowel disease: an update on the population-based literature. J Crohns Colitis 8(11):1351–1361.  10.1016/j.crohns.2014.05.006 CrossRefPubMedGoogle Scholar
  7. 7.
    Louis E, Van Kemseke C, Reenaers C (2011) Necessity of phenotypic classification of inflammatory bowel disease. Best Pract Res Clin Gastroenterol 25(Suppl 1):S2–S7.  10.1016/S1521-6918(11)70003-8 CrossRefPubMedGoogle Scholar
  8. 8.
    Abraham BP, Mehta S, El-Serag HB (2012) Natural history of pediatric-onset inflammatory bowel disease: a systematic review. J Clin Gastroenterol 46(7):581–589.  10.1097/MCG.0b013e318247c32f CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gupta N, Bostrom AG, Kirschner BS, et al. (2010) Incidence of stricturing and penetrating complications of Crohn’s disease diagnosed in pediatric patients. Inflamm Bowel Dis 16(4):638–644.  10.1002/ibd.21099 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Dubinsky MC, Kugathasan S, Mei L, et al. (2008) Increased immune reactivity predicts aggressive complicating Crohn’s disease in children. Clin Gastroenterol Hepatol 6(10):1105–1111.  10.1016/j.cgh.2008.04.032 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Papi C, Festa V, Fagnani C, et al. (2005) Evolution of clinical behaviour in Crohn’s disease: predictive factors of penetrating complications. Dig Liver Dis 37(4):247–253.  10.1016/j.dld.2004.10.012 CrossRefPubMedGoogle Scholar
  12. 12.
    Fletcher JG (2017) Consensus guidelines for evaluation, nomenclature and interpretation for CT and MR enterography in Crohn’s disease patients. Gastroenterology 40:956Google Scholar
  13. 13.
    Kahn E, Markowitz J, Blomquist K, Daum F (1993) The morphologic relationship of sinus and fistula formation to intestinal stenoses in children with Crohn’s disease. Am J Gastroenterol 88(9):1395–1398PubMedGoogle Scholar
  14. 14.
    Freeman HJ (2014) Natural history and long-term clinical course of Crohn’s disease. World J Gastroenterol 20(1):31–36.  10.3748/wjg.v20.i1.31 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Oberhuber G, Stangl PC, Vogelsang H, et al. (2000) Significant association of strictures and internal fistula formation in Crohn’s disease. Virchows Arch 437(3):293–297CrossRefPubMedGoogle Scholar
  16. 16.
    Pfefferkorn MD, Marshalleck FE, Saeed SA, et al. (2013) NASPGHAN clinical report on the evaluation and treatment of pediatric patients with internal penetrating Crohn disease: intraabdominal abscess with and without fistula. J Pediatr Gastroenterol Nutr 57(3):394–400.  10.1097/MPG.0b013e31829ef850 CrossRefPubMedGoogle Scholar
  17. 17.
    Gupta N, Cohen SA, Bostrom AG, et al. (2006) Risk factors for initial surgery in pediatric patients with Crohn’s disease. Gastroenterology 130(4):1069–1077.  10.1053/j.gastro.2006.02.003 CrossRefPubMedGoogle Scholar
  18. 18.
    Kim DH, Carucci LR, Baker ME, et al. (2015) ACR Appropriateness Criteria Crohn Disease. J Am Coll Radiol 12(10):1048–1057.  10.1016/j.jacr.2015.07.005 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Emily S. Orscheln
    • 1
    Email author
  • Jonathan R. Dillman
    • 1
  • Alexander J. Towbin
    • 1
  • Lee A. Denson
    • 2
  • Andrew T. Trout
    • 1
  1. 1.Department of Radiology and Medical ImagingCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Division of Gastroenterology, Hepatology, and NutritionCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations