Which of the following areas is the most common site of fistulas in clients with Crohn’s disease?
A. Anorectal
B. Ileum
C. Rectovaginal
D. Transverse colon
Correct Answer: A. Anorectal
Fistulas occur in all these areas, but the anorectal area is most common because of the relative thinness of the intestinal wall in this area. The initial lesion starts out as an infiltrate around an intestinal crypt. This goes on to develop ulceration first in the superficial mucosa and involves deeper layers. As the inflammation progresses, non-caseating granulomas form involving all layers of the intestinal wall.
Option B: Small bowel follow-through is often used to assess the involvement of the terminal ileum and can also detect fistulas. The classic string sign due to stricture formation or spasm is often seen.
Option C: Granuloma formation is very common in Crohn’s disease but their absence does not exclude the diagnosis. The ongoing inflammation and scarring lead to bowel obstruction and stricture formation.
Option D: It can develop into the classic cobblestone mucosal appearances and skip lesions along the length of the intestine sparing areas with normal mucosa. As the flare of Crohn’s settles, scarring replaces the inflamed areas of the intestines.
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