The three-dimensional (3D) reconstruction of bowel strictures in Crohn’s disease can enhance patient understanding and facilitate multidisciplinary decision-making, offering a promising tool in managing complex cases, according to a recent case study.

Crohn’s disease is a chronic inflammatory bowel condition that may lead to the formation of strictures caused by fibrotic or inflammatory changes. In patients with small bowel involvement, these strictures can cause sub-acute obstruction and symptoms such as pain, bloating and vomiting, which can significantly impair quality of life.

Clinical rationale for 3D imaging

Traditional imaging techniques, such as magnetic resonance enterography (MRE), computed tomography enterography and intestinal ultrasound, provide two-dimensional (2D) depictions of the bowel and surrounding structures.

Although highly valuable for diagnostics, 2D imaging can struggle to convey the full 3D architecture of multifocal or tortuous strictures, thereby limiting shared interpretation among gastroenterology, radiology and surgical teams.

The rationale for using 3D reconstruction was that it could bridge this gap by improving spatial clarity, aiding multidisciplinary team (MDT) communication and enhancing patient understanding and engagement.

Case overview and intervention

In the study by Srinivasan and colleagues, published in JGH Open, a 36-year-old male with post-operative, multifocal, stricturing small-bowel Crohn’s disease and recurrent sub-acute bowel obstructions was evaluated. Imaging demonstrated five distinct strictures differing in length, location and morphological features.

The 3D imaging process drew on the MRE sequences to annotate and generate interactive 3D images of the small-bowel strictures. These models allowed users to manipulate the view in any plane, highlight features such as mural thickness, luminal narrowing and segment length, and identify tortuosity and pre-stenotic dilatation with greater clarity than standard 2D images.

The visualisations were then used in two key settings: first, within the MDT to inform endoscopic feasibility and surgical planning; and second, in a consultation with the patient to facilitate a clearer understanding of his disease burden and the rationale for management decisions.

Key outcomes and clinical implications of 3D imaging

The use of 3D imaging appeared to deliver several benefits. From a clinical team perspective, the shared visual model enabled clearer discussion of complex anatomy, planned procedural approaches and realistic expectations for outcomes.

From the patient perspective, the model improved comprehension of his condition, anatomy and treatment rationale, thereby supporting engagement and shared decision-making. These outcomes suggest that 3D reconstruction may enhance communication loops between clinicians and patients, and among specialists, in complex Crohn’s disease cases.

The introduction of 3D imaging for Crohn’s disease strictures therefore represents a shift toward more personalised, visual medicine. By converting complex anatomical and radiological data into intuitive models, there is the potential to improve diagnostics, procedural planning and patient education.

The authors concluded that future work should evaluate whether 3D models impact clinical utility in supporting medical, endoscopic and surgical decision-making.

In focus: take home messages

  • 3D reconstruction of bowel strictures offers enhanced spatial visualisation compared to conventional 2D imaging in Crohn’s disease
  • Improved anatomical clarity aids multidisciplinary discussion, bringing radiologists, gastroenterologists and surgeons onto the same visual page
  • By ‘seeing’ their own anatomy, patients could gain a tangible understanding of how the altered anatomy contributed to their symptoms, supporting a better comprehension of complex disease, enhancing engagement and promoting shared decision-making
  • Integration of 3D imaging into clinical workflows has the potential to improve procedural planning and personalised care in complex cases
  • Future research should focus on validating 3D imaging in larger cohorts to determine its true impact on clinical outcomes and everyday practice.

Reference
Srinivasan A, Bhatnagar G, Shepherd T. 3D Imaging of Crohn’s Disease Strictures: A Novel Tool to Enhance Patient Understanding and Support Multidisciplinary Decision-Making. JGH Open 2025;9:e70290.