A 25 year old woman woke one morning feeling something wet and warm on her abdomen.When she pulled back the covers,she discovered it was liquid faeces,leaking from a fistulous opening on her abdominal wall,which was soon discovered to have originated in her ileum.She recounted that she had been experiencing diarrhoea for several weeks prior to this event,but had not sought medical attention.At the hospital,a section of small bowel was resected,and the fistula repaired.A representative section of the surgical specimen is shown in the accompanying photomicrograph,with a high power view on the right.Which one of the following is the best diagnosis?

Question

Quizplus · Accepted Answer

Crohn's disease is well-known for creating fistulous tracts.The origin of the ulcers in the small bowel rules out ulcerative colitis,although the two diseases can sometimes overlap if only the colon is involveDThe finding of a granuloma on high power cinches the diagnosis of Crohn's.It may suggest the diagnosis of tuberculosis,but TB granulomas are often caseating.Still,it pays to rule out TB with a skin test,as the immunosuppressive treatment of Crohn's would likely be fatal to a TB patient.

A 25 Year Old Woman Woke One Morning Feeling Something