A 21-year-old man is brought to the emergency room with symptoms of acute intestinal obstruction. His temperature is 38°C (101°F), respirations are 25 per minute, and blood pressure is 120/80 mm Hg. Physical examination reveals a mass in the right lower abdominal quadrant. The patient subsequently undergoes surgery, and a segmental lesion involving the terminal ileum is resected and is shown in the image. Which of the following is the most likely diagnosis?
- Crohn disease is a transmural, chronic inflammatory disease that may affect any part of the digestive tract but occurs principally in the distal small intestine and occasionally the right colon.
- It has variously been referred to as terminal ileitis and regional ileitis when it involves the ileum and granulomatous colitis when it principally affects the colon.
- Skip lesions are common. The affected mucosa has a characteristic “cobblestone” appearance (shown in the image) due to the presence of linear ulcerations and edema, and inflammation of the intervening tissue.
- The other choices do not show the characteristic cobblestone morphology that is seen in this case.