Published in:
01-05-2018 | Clinical Practice: Clinical Images
The Comb Sign in Crohn’s Ileocolitis
Published in: Journal of General Internal Medicine | Issue 5/2018
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A 43-year-old man presented with one day of crampy, diffuse abdominal pain associated with non-bilious, non-bloody vomiting. He reported similar episodes in the past that resolved spontaneously. Physical exam revealed epigastric tenderness. Initial white blood cell count was 13,700/mm3 and the serum C reactive protein was 1.76 mg/dL. Computed tomography (CT) of the abdomen showed a partial small bowel obstruction, ileitis, and the “comb sign” (Fig. 1). Colonoscopy revealed terminal ileal ulcers with luminal narrowing and stricture of the ileocecal valve (Fig. 2); pathology was consistent with Crohn’s ileocolitis.
Fig. 1
CT abdomen with contrast depicting the “comb sign,” characterized by hypervascularity of the mesentery with vascular dilation, tortuosity, and wide spacing of the vasa recta
Fig. 2
Endoscopic view of terminal ileal ulcers with luminal narrowing and stricture of the ileocecal valve, all consistent with Crohn’s ileocolitis
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