A 22-year-old man with inflammatory bowel disease is noted to have a "string sign" in the ileal area on barium enema. In which of the following conditions is this sign most often seen? (See Fig. below.): (A) in the stenotic or non-stenotic phase of the disease, (B) in the stenotic phase only, (C) as a rigid, non-distensible phenomenon, (D) with gastric involvement
Answer is A. The string sign represents long areas of circumferential inflammation and fibrosis. It is seen in the stenotic and non-stenotic phase of Crohn's disease. In addition to the string sign, abnormal puddling of barium and fistulous tracts are other helpful x-ray signs of ileitis. Other radiologic findings in Crohn's disease include skip lesions, rectal sparing, small ulcerations, and fistulas.