What is the morphology of crohn disease?

 Morphology of Crohn’s Disease

The morphology of Crohn’s disease refers to the structural and microscopic changes observed in the gastrointestinal (GI) tract during the disease. These changes can be seen through gross examination (macroscopy) and microscopic (histological) analysis.

Crohn’s disease shows distinct morphological features that help differentiate it from other types of inflammatory bowel diseases, especially ulcerative colitis.

Morphology of Crohn’s Disease


 1. Gross Morphology (Macroscopic Features)

Key Macroscopic Features of Crohn’s Disease:

Feature Description
Segmental involvement ("skip lesions") Diseased segments are interspersed with normal bowel segments
Transmural inflammation Inflammation involves the entire thickness of the bowel wall
Thickened bowel wall Due to inflammation, edema, fibrosis, and muscular hypertrophy
Cobblestone appearance Mucosal ulcerations with raised areas of edematous tissue give a cobblestone-like look
Fissures and ulcers Deep, linear ulcers may extend into the muscularis or serosa
Strictures and stenosis Narrowing of bowel due to fibrosis and chronic inflammation
Fistula formation Abnormal connections between bowel loops or nearby organs (bladder, skin, etc.)
Creeping fat Mesenteric fat extends over the surface of the intestine ("fat wrapping")

 2. Microscopic Morphology (Histological Features)

Key Histopathological Features:

Feature Description
Transmural inflammation Inflammation spans mucosa to serosa (all layers)
Non-caseating granulomas Small clusters of epithelioid histiocytes are seen in 35–60% of cases
Lymphoid aggregates Focal collections of lymphocytes within all layers of the bowel wall
Crypt architectural distortion Irregular crypts, crypt branching, and crypt loss
Mucosal ulceration Focal or extensive mucosal damage
Fibrosis Submucosal and transmural scarring due to chronic inflammation
Neutrophilic infiltration Especially in crypts (cryptitis or crypt abscesses) during active inflammation

 Common Sites Affected

  • Terminal ileum (most common)

  • Ileocecal region

  • Colon

  • Perianal area (with fistulas or abscesses)

  • Mouth (in some cases)

Clinical Importance of Morphology

Understanding Crohn’s disease morphology is essential for:

  • Accurate diagnosis via endoscopy and biopsy

  • Differentiating it from ulcerative colitis

  • Predicting complications (e.g., strictures and fistulas)

  • Guiding surgical and medical treatment


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