CASE HISTORY

Some years ago, whilst resident in the USA, this patient had suffered from Crohn's disease and had had a  segment of gut excised. In 1947 she had a return of symptoms with small bowel obstruction. Barium meal showed localized obstruction in the distal part of the small gut. At operation there were dense old adhesions  and, adjacent to the old site of excision, a recurrence of the disease in the form of a segment of contracted, thick walled gut with hypertrophy of the gut proximal to it. The involved loop was excised and the patient made a good recovery.

PATHOLOGY

The original specimen was about 8" long and has been shortened. The right hand end (proximal) appears  relatively normal. Most of the rest is involved by the disease. The muscularis, which forms a dark layer is thick. The submucosa is very greatly thickened and there is a white streak of fibrosis running along it. The mucosa is thrown into irregular folds by the submucosal thickening so that it has a rather bulbous crazy paving pattern. there is a little ulceration about the junction of the middle and distal (left) thirds. the front of the mesentery had been cut away but no glands can be defined. On the back of the specimen there is evidence of old fibrous adhesions and undue vascularity - presumably residues of the earlier operation.