Cryptogenic multifocal ulcerous stenosing enteritis: Radiologic features and clinical behavior

Figure 1 A 54-year-old man with abdominal pain and anemia. A: Small bowel series spot compression image demonstrates multiple short strictures along the ileum (arrows); B: On axial images of contrast-enhanced computed tomography (CT) enterography, short-segmental strictures (arrows) show moderate and layered bowel wall enhancement with mild dilatation of intervening segment between strictures; C: Gross specimen of resected small intestine shows multiple short segmental strictures (arrows) with mild dilatation of intervening bowel segment, which corresponds with CT images (arrows in B); D: On the low-power H&E staining of surgical specimen (boxed area in Figure 1C) there is a superficial ulcer (arrows) and submucosal fibrosis (arrow heads) without evidence of transmural inflammation or granulomatous lesion (magnification × 10).

Figure 2 A 34-year-old woman with anemia. A: Axial images of contrast-enhanced computed tomography (CT) enterography show segmental bowel wall thickening (arrows) with suspicious strictures along the distal ileum; B: On retrograde double-balloon endoscopic examination at the same time period there are multiple sharply demarcated ulcers at or near the strictures of the ileum; C: Small bowel series spot radiograph obtained two months later reveals segmental luminal narrowing (arrows) along the distal ileum, without overt ulceration; D: On axial images of contrast-enhanced CT enterography after two years, previous bowel wall thickening of distal ileum has improved and prominent strictures are noted at the corresponding ileal segment.

Figure 3 A 49-year-old woman with abdominal pain. A: Coronal reformatted images of computed tomography (CT) enterography show long segmental bowel wall thickening with layered enhancement pattern, involving distal jejunum and proximal ileum. B: This bowel wall thickening of the small intestine is not noted on the coronal reformatted image of CT enterography four years later, and instead, several short-segmental strictures (arrows) have developed in the same bowel loop.

Figure 4 A 45-year-old woman with gastrointestinal bleeding and anemia. A: Small bowel series (SBS) spot compression radiographs show shallow ulcers (arrows) with mucosal fold thickening and subtle luminal narrowing at the ileum; B: After four years, double-contrast SBS spot radiographs demonstrate a severe stricture (arrow) and another stricture with shallow ulceration (arrowhead), suggestive of worsening of previous strictures.