History: A 50-year-old man with abdominal pain undergoes an uppergastrointestinal (GI) series with small-bowel follow-through.
Findings
There are aphthoid lesions within the distal stomach and first portion of the duodenum with a diffuse stricture and fibrostenosis of the first portion of the duodenum. The remaining small bowel is normal.
Differential diagnosis
Crohn's disease
Peptic ulcer disease
Atypical infection
Metastases or primary pancreatic mass
Ischemia
Radiation enteritis
Diagnosis: Gastroduodenal Crohn’s with no other GI involvement
Key points
Crohn's disease
Segmental wall thickening and ulceration anywhere in the GI tract.
Most commonly involves the terminal ileum and colon.
Clinically significant gastroduodenal Crohn's occurs in 0.4% to 5% of cases.
This type of Crohn's frequently presents with postprandial pain.
Aphthoid ulceration is often the earliest finding.
"Ram's horn" sign is the funnel shape of distal antrum and proximal duodenum.
Best diagnosed with double-contrast fluoroscopy.
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