ABSTRACT
Regional ileitis was the name given by Burrill Crohn, Leon Ginzburg and Gordon Oppenheimer 1 (Mount Sinai Hospital, New York) in 1932 to the pathologic and clinical entity they described that has become known as Crohn’s disease. Their report of 14 cases included a detailed pathologic study of resected specimens from 13 of the patients. Regarding the pathologic changes in this inflammatory disease of the terminal ileum, they said, ‘The characteristic, fully developed hypertrophic process is, as a rule, limited to the distal 25 to 35 cm of the terminal ileum … the normal intestinal folds are distorted and broken up by the destructive ulcerative process and rounded and blunted by edema, giving a bullous structure to the mucosal aspect of the intestine, or frequently a cobblestone appearance of the surface of the mucosa may result.’ 1 They did not make use of the cobblestone term in the short discussion of their roentgenographic observations. Only one radiograph was reproduced in the article, it does not show a cobblestone pattern. This gross pathologic appearance was subsequently transferred into the language of radiologists who recognized the same pattern on barium studies done on subsequent patients (Figure 1). There are very few other conditions which cause a similar cobblestone pattern in the terminal ileum thus making it a useful sign. Terminal ileum showing cobblestone appearance. Case courtesy of Dr J. Avalos, Bethesda Naval Hospital https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig16_1_B.jpg"/>
