Common and unusual urogenital Crohn’s disease complications: spectrum of cross-sectional imaging findings

Abstract

Involvement of the urinary tract and genital organs is not uncommon in patients affected with Crohn's disease (CD). Occurring in both sexes, uro-gynecological complications are often clinically unsuspected because of the dominant intestinal or systemic symptoms. Knowledge of their manifestations and cross-sectional imaging appearances is necessary to recognize and report them, since correct medical or surgical treatment choice with appropriate specialist consultation allows to prevent further complications. Besides uncomplicated urinary tract infections that usually do not require imaging, urolithiasis and pyelonephritis represent the most commonly encountered urinary disorders: although very useful, use of computed tomography (CT) should be avoided whenever possible, to limit lifetime radiation exposure. Hydronephrosis due to ureteral inflammatory entrapment and enterovesical fistulization may result from penetrating CD, and require precise imaging assessment with contrast-enhanced CT to ensure correct surgical planning. Representing the majority of genital complication, ano-and rectovaginal fistulas and abscesses frequently complicate perianal inflammatory CD and are comprehensively investigated with high-resolution perianal MRI acquired with phased-array coils, high-resolution T2-weighted sequences and intravenous contrast. Finally, rare gynecological manifestations including internal genital fistulas, vulvar and male genital involvement are discussed.

MRI Enteroclysis and Enterography

“…Several imaging modalities, as the Endoanal Ultrasound, fistulography, CT and MRI, allow the visualization of perianal fistulas [6][7][8][21][22][23][24][25][26][27][28][29]. Among these, endoanal ultrasound provides a good visualization of the intersphincteric plane and the perianal and perirectal soft tissue and is used in the assessment of patients with suspected perianal sepsis, but cannot distinguish areas of fibrosis from the active areas of inflammation and is inadequate for evaluation of ischioanal fossa and supraelevator region [21,24].…”

“…The surgical examination under anesthesia (EUA) has been considered the gold standard for assessing fistulas for years and its tested accuracy is up to 90 % [4,5]. Fistulography [6] and pelvic computed tomography (CT) [7,8] are unlikely to be sufficiently accurate.…”

Imaging findings of urogenital system involvement in Crohn’ s disease: single center experience

“…Mesane tutulumu genellikle uzun dönem CH'nda %2-3,5 sıklıkta görüldüğü bildirilmiştir 1 . Barsak tutulumu mesane komşuluğundaysa mesanede fokal duvar kalınlaşması ve artmış kontrastlanma görü-lebilir.…”

“…CH'nda üriner sistem obstrüksiyonu geniş serilerde %1,9-6 sıklıkta bildirilmiştir 1 . Daha çok sağ alt kadranda, iltihaplanmış terminal ileum, çekum veya sigmoid kolona bağlı ans çevresindeki ödeme bağlı gelişen sekonder inflamatuvar üreterit sonucu üreterde obstrüksiyon görülebilir 8,11 .…”

“…Daha çok sağ alt kadranda, iltihaplanmış terminal ileum, çekum veya sigmoid kolona bağlı ans çevresindeki ödeme bağlı gelişen sekonder inflamatuvar üreterit sonucu üreterde obstrüksiyon görülebilir 8,11 . Uzun dönemde olası renal fonksiyon hasarının engellenmesi için hidronefroz bir an önce tanınmalı ve tedavi edilmelidir 1 . Önceki ça-lışmalarda, CH tanısı sonrasında hidronefroz görülme süresi ortalama 5,6 yıl olarak bildirilmiştir 13 .…”