In Crohn disease, how does an intestinal stricture most commonly present?

• A. Small bowel obstruction
• B. Perforation
• C. Gastrointestinal bleeding
• D. Diarrhea

Answer: (A)

A stricture in Crohn disease is a fixed narrowing of the bowel lumen from chronic transmural inflammation and fibrosis. That fibrotic narrowing tends to block the passage of intestinal contents, so patients commonly present with mechanical signs of obstruction: crampy abdominal pain that comes and goes, abdominal distension, nausea or vomiting, and sometimes the inability to pass gas or have a bowel movement. This is the typical presentation because the lumen is narrowed enough to impede flow, especially in commonly affected segments like the terminal ileum.

Perforation would show as sudden severe abdominal pain with peritoneal signs from a full-thickness wall rupture, which is a different, less common complication of Crohn. Bleeding results from ulceration of the mucosa and can cause hematochezia or melena, not the fixed narrowing itself. Diarrhea can occur with active inflammation but is not the characteristic presentation of a discrete stricture, which is defined by the obstructive symptoms due to luminal narrowing.