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PubMed1995

[Adult cyclic neutropenia: acute ileitis as an initial clinical manifestation].

Cyclic neutropenia is a rare disease in which blood neutrophils periodically decrease and almost disappear, ensuing acute infections of variable severity. We report a 37 years old female presenting with severe abdominal pain, fever and neutropenia. During a surgical abdominal exploration, an acute ileitis was found. During a follow-up of 6.5 months, transient episodes of neutropenia (mean count of 0.33 x 10(9)/l), every 22-28 days, were detected. Coinciding with these episodes, band and segmented neutrophils disappeared from the bone marrow and its response to functional stimulation with prednisone was insufficient. No cyclical changes in lymphocytes, monocytes and packed red cell volume were observed. The episodes of severe transient neutropenia and infections persist after three years of follow up.

Acute Disease↗
PubMedDate not supplied

[Perforation in Crohn's ileitis and its consequences in the natural history of disease. 2. Consequences of perforation in the peritoneal cavity: diffuse septic peritonitis, abscesses, external and internal fistulas].

Perforation of Crohn's ileitis occurring in the peritoneal cavity is always free perforation, but it causes usually a localized peritonitis, i.e. an abscess, and only in rare cases a diffuse septic peritonitis for the reasons expounded in the Part 1. Diffuse septic peritonitis has the common features of all perforative peritonitis; its surgical treatment must be ileocolic resection, simple suture of perforation being a serious mistake. Abscesses develop: as regards the ileum, about 30-45 cm from the ileo-caecal valve; as regards the abdominal cavity, in the right iliac fossa or in the pelvis, at a site where the ileum, weighed down by its chronic inflammation, rests. These abscesses have a wall like that of all abscesses, with no specific crohnian features. On operation, if technical considerations so require, part of the abscess wall may be left in place with no fear of recurrences or fistulas. Nowadays, most abscesses of the right iliac fossa are opened surgically; an enterocutaneous fistula follows. Most abscesses of the pelvis still open spontaneously into a hollow organ (sigma-rectum, urinary bladder), and rarely into the vagina or onto the perineum after penetrating through the levator any muscle and causing suppuration of the ischiorectal fossa.

Abdominal Abscess↗
PubMed1996

Mode of food intake reduction in Lewis rats with indomethacin-induced ulcerative ileitis.

The mechanism of anorexia in inflammatory bowel disease is poorly understood. To gain insight into possible pathophysiologic mechanisms, the feeding indices and food intake were studied in an animal model of Crohn's disease. The anorexia of indomethacin-induced ulcerative ileitis was compared with that of the well-known anorexia of total parenteral nutrition (TPN). Forty-five female Lewis rats were randomized to four groups: Control, Indomethacin, Indomethacin + TPN, and TPN. Feeding indices and food intake were continuously measured using the Automated Computerized Rat Eater Meter. Interleukin-1 alpha (IL-1 alpha), tumor necrosis factor-alpha (TNF-alpha), prostaglandin E2 (PGE2), and leukotriene B4 (LTB4) were assayed in plasma, mononuclear cell culture, or ileum to determine their role in mediating anorexia. In the TPN group, spontaneous food intake (SFI) decreased (52%; p < 0.05), primarily via reduction in meal number (MN, 54%; p < 0.05) and, to a lesser extent, meal size (MZ, 35%; p < 0.05). In comparison, in the Indomethacin group SFI decreased (74%; p < 0.05) primarily via reduction in MZ (67%, p < 0.05); MN also decreased but to a lesser extent (27%; p < 0.05). In the Indomethacin + TPN group, SFI decreased (55%; p > 0.05) primarily via reduction in MN (79%; p < 0.05), whereas MZ decreased slightly (19%; p < 0.05). Only in the Indomethacin group were IL-1 alpha and TNF-alpha detected in the mononuclear cell culture and plasma, respectively. In the Indomethacin group, an inverse correlation existed between MZ and TNF-alpha (p < 0.05). In the Indomethacin group, IL-1 alpha, PGE2, and LTB4 concentrations did not correlate with feeding indices. SFI reduction in this model was mediated primarily via a decrease in MZ. TNF-alpha is proposed to mediate this effect and TPN was shown to overcome the effect on MZ.

Animals↗
PubMed1997

Eosinophilic ileitis with perforation caused by Angiostrongylus (Parastrongylus) costaricensis. A case study and review.

Angiostrongylus costaricensis (classified under the more specific genus Parastrongylus by different authors) is a filiform intestinal nematode endemic to Central and South America, which afflicts primarily the pediatric population 1 to 13 years of age. Only three cases of adult infections have been previously documented outside the endemic region. To our knowledge, we report the first such case in the western United States, as well as the oldest patient yet recorded. Our patient is a 73-year-old woman living in Los Angeles who presented with an acute abdomen 4 weeks following a 5-month visit to El Salvador. Examination of the gross ileum removed at exploratory laparotomy revealed a perforation associated with a segmentally thickened intestinal wall. Microscopic examination showed eosinophilic ileitis, arterial lumens containing nematodes morphologically consistent with A costaricensis, eggs in the submucosa, and arteriolitis with thrombosis.

Aged↗
PubMed1990

Enterovesical fistula from Meckel's diverticulum in a patient with Crohn's ileitis.

Formation of a fistula from a Meckel's diverticulum to the bladder is extremely rare and may not be recognized, especially in patients with other gastrointestinal disease. We describe a patient with Crohn's ileitis who was assumed to have two enterovesical fistulae from his diseased ileum. Laparotomy revealed a Meckel's diverticulum with fistulization to the bladder. The diverticulum contained inflamed and ulcerated ectopic gastric mucosa but was not affected by Crohn's disease. We know of only one other report of an enterovesical fistula resulting from a Meckel's diverticulum. In that case, however, the diverticulum did not contain ectopic tissue.

Adult↗
PubMed1997

Conservative surgical management of terminal ileitis: side-to-side enterocolic anastomosis.

PURPOSE: Terminal ileitis is the most frequent presentation of Crohn's disease. Resection of the terminal ileum and cecum with ileocolic anastomosis has always been considered the "gold standard" in the surgical treatment of this condition. This study illustrates an alternative technique referred to as "side-to-side enterocolic anastomosis." METHODS: It consists of a longitudinal section of the terminal ileum starting 1 to 2 cm away from the beginning of the stricture and continued for a similar length on the ascending colon. A side-to-side anastomosis is then fashioned, in a kind of Finney-shaped strictureplasty. A series of five patients is reported. RESULTS: Average length of the anastomosis was 18.4 (range, 12-25) cm. Postoperative course was uneventful. Colonoscopy and large-bowel enema performed on some patients six months after surgery revealed a complete morphologic regression of the disease. All patients are presently in good condition, with no evidence of recurrence after an average follow-up of 8.9 (range, 6-15) months. CONCLUSIONS: "Side-to-side enterocolic anastomosis" can be a possible alternative option for the surgical management of Crohn's disease of the terminal ileum, providing at least regression of the morphologic aspects of the disease. Contraindications are presence of abscesses, fistulas, or rigid and fibrotic stricture. This technique can be considered a further example of nonresectional surgery such as strictureplasty. This makes it possible to conceive surgical treatment of Crohn's disease without resection in selected cases for the whole length of the small bowel and suggests the introduction of the new definition of "conservative surgical management of small-bowel Crohn's disease."

Adult↗
PubMed1997

Rapid spinal trabecular bone loss in female patients with ileitis terminalis Crohn and additional sacroiliac joint inflammation.

Patients with Crohn's disease are well known to have local and generalized osteopenia of varying degrees. The aim of this study was to investigate whether the additional involvement of the sacroiliac joint as an extraintestinal manifestation has an influence on bone turnover in female patients with Crohn's disease. Osteocalcin and other parameters of bone metabolism were measured in 79 female patients with Crohn's disease. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DEXA). Z scores were obtained by comparison with age- and sex-matched normal values. As regards the sacroiliac involvement (n = 26; group 1), we found a significantly lower BMD in the lumbar spine (L4) and in Ward's triangle of the femoral neck compared to controls (P < 0.05) and those patients (n = 53; group 2) with pure ileitis terminalis Crohn. Furthermore, the duration of the disease process in patients with Crohn's disease and extraintestinal involvement was markedly shorter than that of patients in group 2 (P < 0.05). In conclusion, osteoporosis in female patients with sacroiliac involvement manifested itself in a more severe way.

Adult↗
PubMed2003

Terminal ileitis with sealed perforation--a rare complication of intestinal endometriosis: case report and short review of the literature.

INTRODUCTION: Perforation is a rare complication of intestinal endometriosis. We report on a 38-year-old patient with previously known rectovaginal and ileocecal endometriosis who was referred with an acute abdomen. CASE REPORT: On abdominal plain film an ileus of small intestine was diagnosed. The patient had fever, and the C-reactive protein was markedly increased. Upon emergency laparotomy an acute terminal ileitis with omentum-sealed perforation and a stenosis of the anterior wall of the rectum due to endometriosis were found. Partial resection of the ileum with end-to-end anastomosis, appendectomy, and short segmental rectum resection were performed. The postoperative course was uneventful. Histological examination corroborated the intraoperative diagnosis of fistulas, perforation and deep ulceration of the intestine consistent with transmural endometriosis. DISCUSSION: For proper care of these patients excellent cooperation between gynecologists and general surgeons is desirable. A short review of the literature concerning intestinal endometriosis is given.

Adult↗
PubMed1981

Combined suppurative and noncaseating granulomatous oophoritis associated with distal ileitis (Crohn's disease).

A nulliparous 30-yr-old woman, presenting with nonspecific systemic symptoms, was found radiologically to have distal ileitis (Crohn's disease). A partial ileocolectomy was done along with excision of the firmly adherent right adnexa. Pathologically, the ovary showed a suppurative oophoritis related to an ileo-ovarian fistula and a noncaseating granulomatous inflammatory response similar to that found in the ileum.

Adult↗
PubMed2005

Henoch-Schönlein purpura presenting as terminal ileitis and complicated by thrombotic microangiopathy.

We report here on a 40-year-old woman with abdominal pain, low-grade fever, and diarrhea in whom the cutaneous features of Henoch-Schönlein purpura (HSP) appeared only a few days after acute abdominal symptoms. Endoscopy showed terminal ileitis, and histopathological examination of a biopsy of the ileum showed a picture of IgA vasculitis. The clinical course was further complicated by the development of microangiopathic hemolytic anemia, thrombocytopenia, and severe renal failure.

Journal Article↗
PubMed1984

Ileoscopic diagnosis of terminal ileitis.

Crohn's disease of the bowel is usually diagnosed by complete barium contrast studies of the gastrointestinal tract. However, at times, in spite of a high index of clinical suspicion, the radiologic diagnosis is not conclusive. In the present report, we describe five patients with Crohn's ileitis in whom the diagnosis was established only at ileoscopy.

Adolescent↗
PubMed2001

Acute terminal ileitis, yersiniosis, and Crohn's disease: a long-term follow-up study of the relationships.

Background: During the past decade, very little has been published on the relationships between Yersinia enterocolitica, acute terminal ileitis (ATI), and Crohn's disease, possibly due to a decrease in Yersinia infections and, consequently, in ATI. Methods: Fifty-three patients admitted to Herlev University Hospital during the period 1976-1998 were diagnosed as having ATI while undergoing surgery for suspected acute appendicitis. The patients were followed up, and both Yersinia titers and the development of Crohn's disease were registered. Results: Forty-four patients (83%) were tested for Yersinia, 17 of whom (39%; 95% confidence limits, 24-55%) were positive. The incidence of yersiniosis in ATI decreased significantly during the observation period (P<0.05), whereas the incidence of ATI itself was unchanged. Thirteen of the 53 patients (25%; 95% confidence limits, 14-38%) had, in addition to ATI, an inflamed appendix. Three patients developed Crohn's disease during a median observation period of 13 years (cumulative risk 6.1%). None of them had yersiniosis. Conclusions: The incidence of ATI remained stable during the observation period, even though the number of Yersinia infections decreased. This may have been due to an increase in gastrointestinal infections caused by other enteric pathogens. In accordance with previous findings, ATI patients who developed Crohn's disease did not have yersiniosis. Thus, it is still of prognostic value to test patients with ATI for Yersinia and perhaps for other enteric pathogens as well.

Journal Article↗
PubMed2002

Spontaneous terminal ileitis resembling Crohn disease in captive tamarins.

Five tamarins (four Saguinus mystax and one S. labiatus) died with wasting syndrome characterized by chronic diarrhea at the Center for Reproduction and Conservation of Non-Human Primates in Iquitos, Peru. At necropsy, the terminal ileum of all affected tamarins was found to be markedly thickened. Histologically, the terminal ileal mucosa was completely ulcerated, and effaced by debris and mononuclear inflammatory cells. The submucosa and serosa were thickened by fibroplasia, mononuclear cell infiltrates and variable edema. No infectious agent was observed. The lesions were similar to those described previously for Crohn disease. This is to our knowledge the first report of terminal ileitis resembling Crohn disease in non-human primates.

Animals↗
PubMed2002

Acute terminal ileitis associated with pneumococcal bacteremia: case report and review of pneumococcal gastrointestinal diseases.

In this report, we describe a patient with acute terminal ileitis due to Streptococcus pneumoniae, review 3 previously reported cases of isolated enteritis due to S. pneumoniae, and summarize the English-language literature on primary and secondary pneumococcal gastrointestinal diseases. Various theories have been advanced to explain the pathogenesis of this rare and potentially life-threatening form of pneumococcal infection, but the mechanism by which S. pneumoniae causes gastrointestinal disease is still unknown.

Acute Disease↗
PubMed1975

Carcinoma of the small intestine associated with transmural ileitis (Crohn's disease).

A case of adenocarcinoma of the small bowel arising in pre-existing transmural ileitis (Crohn's disease) is reported and 28 previously reported cases are reviewed. Carcinoma associated with transmural enteritis occurs more often in the distal ileum, in younger patients, and in more males than expected from published data on carcinoma not associated with transmural enteritis. If the patient has had exclusion procedures, the carcinoma has been found to arise in the excluded bowel segment.

Adenocarcinoma↗
PubMed1990

Erythrocyte sedimentation as a measure of Crohn's disease activity: opposite trends in ileitis versus colitis.

To test our hypothesis that the erythrocytic sedimentation rate (ESR) correlates well with clinical activity in inflammatory disease of the colon, but not of the small bowel, we stratified 49 Crohn's disease patients according to their anatomic involvement and then measured the correlations between ESR and clinical activity within each of these anatomical subgroups. For 18 patients with Crohn's disease involving primarily the colon, there was a trend toward a direct correlation between clinical score and ESR (p = 0.15). In the 14 patients with Crohn's disease limited to the colon, this direct correlation was even more pronounced and statistically significant (p less than 0.02). By contrast, an opposite trend was observed for patients with small bowel disease. For the 26 patients with disease involving predominantly the small bowel, as well as for the 22 with disease limited to small bowel, there were statistically significant inverse correlations between clinical score and ESR (p less than 0.04). This difference between the directions of the correlations for Crohn's colitis versus ileitis was statistically significant (p less than 0.05). This study provides further evidence for the importance of analyzing putative indications of disease activity separately for each of the protean forms in which Crohn's disease occurs.

Blood Sedimentation↗
PubMed2006

Role of interleukin 6 in a murine model of Crohn's ileitis: are cytokine/anticytokine strategies the future for IBD therapies?

Although the precise causes of inflammatory bowel disease (IBD) have yet to be discovered, important therapeutic advances have resulted from the manipulation of cytokine function(s) using anticytokine/cytokine therapies, such as targeting of tumor necrosis factor. We discuss the future of this area of investigation in the context of preclinical experimentation using animal models of IBD. In particular, we pinpoint the roles played by interleukin 6 and its intracellular signalling pathways in the SAMP1/Yit murine model of Crohn's-like ileitis.

Animals↗