Fistulizing Crohn’s Disease Complicated by Hidden Retroperitoneal Abscess: A Case Report and Review of the Literature

Abstract

Crohn’s Disease (CD) is a chronic inflammatory disorder of the intestinal tract characterized
by trans-mural damage of the bowel wall often complicated by strictures, entero-visceral
and perianal fistulae and abscesses. Both computed tomography and magnetic resonance
enable clear visualization of the involved intestinal tract together with various extra- and intraintestinal
complications. Herewith, the uncommon case of a hidden retroperitoneal abscess
with para-vertebral collection, as a consequence of a penetrating CD of the terminal ileum, is
described. Retrofascial collections, due to fistulizing CD, are rare events often misdiagnosed
or even recognized late in the clinical course and associated with severe and potentially lifethreatening
consequences. Prompt assessment with cross-sectional imaging is necessary. MR
imaging is being more frequently used in the follow-up of CD since the lack of ionizing radiations
which avoids any biological impact in these patients.