In inammatory bowel disease, disease manifestations outside the intestinal tract (i.e., extraintestinal disease manifestations) can eect eyes, joints, skin, and other systems [10]. Although mesenteric disease manifestations are characteristic of Crohn’s disease, they are remark­ably understudied. Fat wrapping and mesenteric thicken­ing may be conceptually combined to generate a scoring mechanism that allows the quantitation of mesenteric disease, and its correlation with other disease activity scoring systems (Figure 7.2). Emerging data indicate that the mesenteric disease scores correlate with the Crohn’s disease activity index (CDAI), as well as with increasing levels of mucosal disease. Data suggests that smoking leads to a signicant deterioration in mesenteric disease scores. is is highly relevant as smoking is known to worsen Crohn’s disease and increases the risk of disease recurrence requiring surgery [8,11–13]. is combination of ndings suggests that the mesentery is sensitive to the negative eects of smoking in Crohn's disease. It suggests that mesenteric events are of primary pathobiologic sig­nicance in this condition (Figure 7.2).