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[Perforation in Crohn's ileitis and its impact on the natural history of the disease. Note 1. Pathogenic process of the event, its relationship with intestinal obstruction, and its immediate consequences].

The pathogenesis and consequences of perforation in Crohn's disease were studied in 175 patients submitted to surgery. Perforation occurred in 40 (23%) patients with ileitis or ileocolitis, always in the terminal ileum; so-called "free" perforation occurred in 1 patient, "limited" perforation in all the others. Perforation is always a consequence of a chronic intestinal obstruction caused by the stricture of the terminal ileum, which becomes absolute because of the blocking by solid intestinal content. It occurs in the borderline between the stricture and proximal dilated loop, where the fissures (typical of Crohn's ileitis) are stretched to the utmost and dilated by the hyperpressure and distension of the wall following ileal stenosis. Perforation in the peritoneal cavity is always free; its consequence is usually not a diffuse septic peritonitis but an abscess, because only a small amount of intestinal content leaks out. This happens because in the proximal occluded bowel, pressure decreases abruptly following the spilling of intestinal content, particularly of gas. The abscess fed by intestinal content enlarges and finally opens into a hollow organ or onto the skin, causing a fistula (internal or external). The rational therapeutic approach to perforation and its consequences (the infrequent diffuse septic peritonitis, or the more common abscesses and fistulas) is always and only ileal stenosis removal.

Crohn Disease↗
PubMed1976

Acute yersinial ileitis: a distinct entity.

A case report of documented Yersinial acute ileitis is presented. A review of the literature reveals that progression to Crohn's disease is uncommon. Yersinosis can present as several symptom complexes. Mesenteric lymphadenitis and terminal ileitis, however, appear to be the most common. The diagnosis is usually made during laparotomy for possible appendicitis, because the symptom complex may be very similar. If the only finding at laparotomy is a thickened edematous ileum, postoperative titers for Yersinia should be taken. A greater awareness is necessary before the true incidence and epidemiology can be ascertained.

Acute Disease↗
PubMed1977

Acute terminal ileitis and Yersinia enterocolitica infection.

Diarrhea, moderate to high fever and pain in the RLQ associated with a tender mass or swelling of the terminal ileum arouse suspicion of acute terminal ileitis. Will diagnostic of the disease be laboratory data compatible with acute inflammatory disease and radiological findings of the terminal ileum, i.e., thickening of mucosal folds, round filling defects on the mucosa indicative of swelling of lymphoid tissue and fine irregularities of the margin without narrowing of the lumen. Yersinia infection was demonstrated in 7 of 10 patients whose stool and/or serum were examined. Yersinia enterocolitica was found to be an important causative agent of acute terminal ileitis. Its detection will be useful for differentiating the disease from acute stage of Crohn's disease.

Acute Disease↗
PubMed1974

Acute terminal ileitis and Yersinia infection.

Acute terminal ileitis was for many years thought to be due only to Crohn's disease, though most patients found at laparotomy to have this condition did not progress to the chronic form of Crohn's disease. A case of acute terminal ileitis due to Yersinia pseudotuberculosis is presented here to draw attention to another, perhaps predominant, cause of this condition.

Antibodies, Bacterial↗
PubMed1968

Bile salt malabsorption in regional ileitis, ileal resection and mannitol-induced diarrhea.

Fecal bile salt excretion was studied in healthy volunteers, patients with regional ileitis, and patients with ileal resection. 10 muc of carboxyl-(14)C-cholic acid was given orally. Stools and urine were collected daily for 5-10 days, the bile salts extracted, and the radioactivity assayed. Urinary excretion was negligible. All patients with ileal resection excreted bile salts in the feces significantly faster than controls, and five of the six excreted 50% of the radioactivity within 24 hr. Their mean intestinal transit time was 5.6 hr compared to 26 hr for the controls. Two of the three patients with regional ileitis excreted bile salts almost as rapidly as patients with ileal resection. Vitamin B(12) absorption was also defective in those patients, but the intestinal transit time was not decreased. To study the effect of rapid intestinal transit on bile salt excretion, four of the control subjects were given orally 1200 ml of 10% mannitol for 7 days, and the labeled cholic acid excretion rate was again studied. The mean intestinal transit time was markedly shortened, mild steatorrhea developed, and the fecal bile salt excretion rate increased slightly. It is concluded that ileal resection and ileal disease are major factors and rapid intestinal transit is a minor factor in causing excessive fecal bile salt loss. The relevance of bile salt wastage to lipid malabsorption is unknown because of insufficient information about compensatory jejunal absorption, maximum rate of hepatic bile salt synthesis, and the minimum necessary intraluminal concentration of conjugated bile salt.

Bile Acids and Salts↗
PubMed1976

Studies on Crohn's disease. 1. The relationship between Yersinia enterocolitica infection and terminal ileitis.

Patients with terminal ileitis or regional enterocolitis have been examined for signs of infection due to Yersinia enterocolitica serotype 3. The patients were grouped according to the length of preoperative history. Among 18 patients with preoperative symptoms of one week or less there were nine with positive signs of Yersinia enterocolitica infection. None of these patients developed the chronic form of Crohn's disease while two of the primarily Yersinia negative patients progressed to the chronic form. Among nine patients with preoperative symptoms of one week to three months there was one patient with positive signs of Yersinia enterocolitica infection. This patient has remained healthy whereas seven of the negative ones progressed to the chronic form of Crohn's disease. None of the patients with established Crohn's disease of the chronic form had signs of recent Yersinia infection. The findings indicate that patients with acute terminal ileitis and positive signs of Yersinia infection are not likely to progress to the chronic form of Crohn's disease. Bacteriologic and serologic investigation for Yersinia infection are therefore of prognostic value.

Acute Disease↗
PubMed1989

Small bowel angiodysplasia in association with Crohn's ileitis. A case report.

A case of a female patient affected by Crohn's ileitis associated with small bowel angiodysplasia is reported. Despite a good clinical and laboratory response to steroid therapy the patient showed an unexplained hypochromic microcytic anemia. At laparotomy Crohn's ileitis as well as an angiodysplastic lesion were found. Both lesions were resected in continuity. During a 2-year follow-up the patient did not show anemia despite pregnancy. It is suggested that the angiodysplastic lesion was the possible cause of hypochromic anemia and that the patient should have been operated on before, based on her recurrent anemia.

Adult↗
PubMed1982

[Pulmonary and cutaneous lesions and terminal ileitis in a 11-year-old child: an exceptional case (author's transl)].

A 11-year-old child presented with terminal ileitis associated with pulmonary lesions showing periodic progression. The initial thoracic disorder developed two years before radiological evidence of the ileitis, the second episode coinciding with the diagnosis of the ileal lesion. Pulmonary lesions progressed simultaneously with the clinical signs of digestive tract disturbances, which are now stabilized. The exceptional cases of respiratory affections in Crohn's disease reported in the published literature are reviewed. The diagnosis of these little known associations is still further complicated by the fact that iatrogenic pulmonary affections can sometimes be induced by Salazopyrin, employed to treat this disease.

Child↗
PubMed1977

Long-term results in the treatment of regional ileitis with coherin.

Nineteen patients with severe symptoms of ileitis, not responsive to other forms of therapy, have been treated with coherin, a peptide isolated from bovine posterior pituitary glands. This study encompasses observations over a total of 50-patient years. tcoherin has proven efficacious by three criteria: As a result of coherin treatment those patients receiving steroids could either eliminate them or reduce the dosage to safe levels. A significant number of patients whose symptoms have been controlled by coherin have demonstrated their therapeutic dependence on coherin for relief of symptoms by multiple unsuccessful attempts to discontinue treatment over a long period of time. Diarrhea, in patients with ileitis symptoms, is effectively controlled by coherin therapy on a long-term basis.

Crohn Disease↗
PubMed1976

Regional ileitis (Crohn's disease). I. Kinetics of bile acid absorption in the perfused ileum.

Bile acid absorption was studied by steady state perfusion technique in the ileum of 11 patients with regional ileitis (Crohn's disease). By computerizing absorption kinetics the presence of an active transport of glycochenodeoxycholic acid (GCDC) was rendered probable by finding a saturable transport system and a competitive absorption between conjugated bile acids. At the time of investigation 5 patients had no diarrhoea, whereas 6 patients had diarrhoea as defined from the amount of faecal output. In the former group the faecal bile acid excretion was low, the ileal absorption of GCDC high, and judged from the xylose absorption the ileal absorption surface large compared to the latter group, in which the faecal bile acid excretion was high, the ileal absorption of GCDC low, and the ileal absorptive surface small. It is concluded that malabsorption of bile acids in the ileum may be of significant physiological importance in the pathogenesis of diarrhoea in patients with regional ileitis.

Adult↗
PubMed1976

Regional ileitis (Crohn's disease). II. Electrolyte and water movement in the ileum during perfusion with bile acids.

Electrolyte and water movement was studied by steady state perfusion technique in the ileum of 11 patients with regional ileitis (Crohn's disease). Six patients who at the time of investigation had diarrhoea showed a constant secretion of salts and fluid during perfusion with control perfusate. Per 24 hours, the ileal effluents to colon would exceed the normal amount by 1-2 litres. In the 5 patients without diarrhoea the absorption patterns were normal. Electrolytes and water moved in parallel. Dihydroxy bile acids enhanced secretion or decreased absorption respectively, in the two groups of patients. It is concluded that functional disturbances of salt and water absorption in the inflamed ileum may be of significant physiological importance in the pathogenesis of diarrhoea observed in patients with regional ileitis.

Adult↗
PubMed1987

Prediction of surgery for obstruction in Crohn's ileitis. A study of 64 patients.

The charts of 64 patients with Crohn's ileitis were reviewed to determine what characteristics at the time of first observation at a specialized center were predictive of surgery for irreversible obstruction, using Cox's proportional hazard model. Individual variables which proved significant (P less than 0.01) included age at presentation to the clinic, serum albumin, sedimentation rate, and the presence of radiologic strictures. Patients eventually requiring surgery were older than the rest because of a later date of symptom onset; furthermore, patients with strictures on initial x-rays had not been ill for a longer period of time than those who did not have strictures. These data suggest that fibrosis and stenosis are characteristic of a subgroup of Crohn's patients, rather than being inevitable phases of disease evolution. Multivariate analysis revealed that patients with low serum albumin, high sedimentation rate, and roentgenologic stenosis at first observation were ten times as likely to require surgery for obstruction at 10 years than those without any of these three unfavorable parameters.

Adult↗
PubMed1984

Computed tomographic diagnosis of radiation ileitis.

Two patients were studied by CT after resection of colon carcinoma followed by abdominal radiation therapy. Based upon the findings of a localized, mass-like confluence of shortened loops of bowel with thickening of bowel wall, adherence of adjoining loops, thickening of the adjacent mesentery, and increased density of mesenteric fat the patients were considered to have radiation ileitis. Recurrent tumor was excluded by autopsy and confirmed by a 1-year asymptomatic follow-up period.

Adenocarcinoma↗
PubMed2003

Obstructive ileitis secondary to colon cancer: report of a case.

We report a case of obstructive ileitis (OI) secondary to colon cancer. A 62-year-old man was hospitalized for abdominal pain and a feeling of fullness. Examinations revealed a mechanical ileus caused by an obstructing carcinomatous lesion of the cecum. He underwent laparotomy on the tenth hospital day, and a right hemicolectomy was carried out with resection of the distended and edematous ileum. The histopathologic diagnosis was adenocarcinoma in the cecum involving the ileocecal valve and nonspecific inflammatory change of the ileum, with mucosal necrosis and neutrophilic infiltration involving the subserosal layer. His postoperative course was uneventful. OI does not always show similar histological features to obstructive colitis; however, they are both important types of obstructing lesions, and their possibility must be kept in mind during colorectal cancer surgery.

Adenocarcinoma↗
PubMed1985

Demonstration of a new intracellular antigen in porcine intestinal adenomatosis and hamster proliferative ileitis.

In the proliferate enteropathies of the pig, intracellular Campylobacter-like organisms can be demonstrated in the apical cytoplasm of affected cells. A new antigen (omega) can be visualised at the site of bacterial parasitism using certain rabbit sera in a sandwich immunofluorescence test; the rabbit sera tested were largely derived from rabbits immunised with bacterial antigens including Campylobacter spp., but it appeared that the reaction was not related to the immunisation procedure and was also present in at least one "normal" rabbit serum. Rabbits immunised with bacteria extracted from the tissues sero-converted to omega-antigen yet did not react with Campylobacter spp., cultured from pig intestine. The omega-antigen was also present in the lesions of hamster proliferative ileitis.

Animals↗
PubMed2006

Cytomegalovirus ileitis associated with goblet cell carcinoid tumour of the appendix.

We report a female patient with cytomegalovirus (CMV) terminal ileitis and CMV viraemia, associated with a metastatic goblet cell carcinoid (GCC) tumour of the appendix. She was treated with ileocaecal resection followed by ganciclovir. We highlight the importance of vigilant histopathological assessment and discuss the existing literature on gastrointestinal CMV infection in immunocompetent patients.

Antiviral Agents↗
PubMed1987

Terminal ileitis associated with Mycobacterium avium-intracellulare infection in a homosexual man with acquired immune deficiency syndrome.

A 38-yr-old homosexual man developed fever, diarrhea, and weight loss. An upper gastrointestinal examination revealed terminal ileitis, and stains of stool revealed acid-fast bacilli that were subsequently identified as Mycobacterium avium-intracellulare. Antimycobacterial therapy was associated with weight gain and loss of fever and diarrhea. Several months later, cutaneous Kaposi's sarcoma was observed. When the patient developed strictures in the terminal ileum, a surgical resection was performed. Numerous granulomas and acid-fast bacilli, later identified as M. avium-intracellulare, were present in the resected terminal ileum. This report demonstrates that infection of the terminal ileum with M. avium-intracellulare in a patient with acquired immune deficiency syndrome can present with a clinical and radiologic picture resembling Crohn's disease. It also demonstrates symptomatic improvement of this infection temporally related to the administration of antimycobacterial therapy and the ability of an acquired immune deficiency syndrome patient to tolerate major abdominal surgery.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Pathogenic Escherichia coli: a new etiology for acute ileitis in children.

Acute ileitis in children is frequently diagnosed at the time of laparotomy for acute abdominal pain and is usually due to inflammatory bowel disease, Yersinia, or Campylobacter infections. We report a case in which a pathogenic strain of Escherichia coli was responsible for the disease. The diagnosis, microbiology, and epidemiology are discussed.

Abdomen, Acute↗