| A case of terminal ileitis, mesenteric lymphadenitis and appendicitis is reported. Serological studies indicated infection with yersinia pseudotuberculosis type VA. The patient's illness ran a chronic course necessitating resection of the terminal ileum. Histological examination of the appendix and a mesenteric lymph node in the acute stage revealed granulomas with central necrosis. This is the first human case in which the subtype VA has been identified. ( info) |
2/148. Coincidence of Crohn's disease and a high-risk gastrointestinal stromal tumor of the terminal ileum. A 51-year-old male patient presented with characteristic radiologic features of Crohn's disease in the terminal ileum plus a large tumorous lesion in the right lower abdomen. Because of rapid crescent symptoms of bowel obstruction, the patient underwent surgery revealing a high-risk gastrointestinal stromal tumor (GIST) of the terminal ileum within an area of Crohn's ileitis. Whereas the association of chronic inflammatory bowel disease (IBD) and gastrointestinal adenocarcinoma is well known, other primary intestinal tumors are rare in these patients, particularly at the time of onset of clinical symptoms. This is the 3rd patient reported in the literature with a sarcoma complicating IBD, and in fact, the first description of the coincidence of Crohn's disease and GIST. Though the present case is likely to be a mere coincidence of two pathologically distinct entities (without any potential causal relationship), it should remind one of the possibility of small bowel 'Crohn's carcinoma' in patients with a sudden change in symptomatology as well as in those in whom intestinal obstruction fails to resolve with adequate therapy. ( info) |
3/148. Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. intestinal obstruction and bleeding are uncommon complications of congenital syphilis (CS). A VDRL-positive infant developed incomplete intestinal obstruction and rectal bleeding. Despite conservative management, his symptoms continued. At laparotomy, terminal ileal inflammation and stenosis were demonstrated. He underwent ileal resection and primary end-to-end anastomosis with resolution of his symptoms. Histopathological examination demonstrated heavy plasmacytic infiltration of the lamina propria and submucosa with ulceration of the mucosa, consistent with syphilitic ileitis. This report documents for the first time bleeding from ileal ulcers associated with intestinal obstruction in CS and highlights an unusual presentation of the disease. ( info) |
4/148. Skip colonic ulceration in typhoid ileo-colitis. Colonic skip lesions are typically described in Crohn's colitis, but this phenomenon has been recognized in ulcerative colitis (skipped appendiceal involvement), Behcet's colitis, cytomegaloviral colitis, and even in aeromonas hydrophilia and histoplasma capsulatum infection. However, skip lesions in typhoid ileo-colitis have not been reported in the English-language literature. We report herein a patient with skip ulcers due to typhoid fever. ( info) |
| A 17-year-old boy presented with fournier gangrene associated with previously undiagnosed Crohn ileocolitis. fournier gangrene was managed by debridement, broad-spectrum antibiotics, and hyperbaric oxygen. A diverting ileostomy was performed before skin grafting and scrotal reconstruction. microscopy of a full-layer surgical sample from the terminal ileum revealed granulomas with multinucleated histiocytes, consistent with crohn disease. crohn disease was treated with mesalamine, metronidazole, 6-mercaptopurine, and infliximab. The patient was discharged on hospital day 32. At 6-month follow-up, reconstruction of his scrotum had completely healed. Ostomy output was normal. ( info) |
6/148. Eosinophilic ileocolitis secondary to enterobius vermicularis: case report. We describe an unusual presentation of enterobius vermicularis infestation. Computed tomography showed wall thickening in the distal ileum and cecum, with fat stranding, ascites and mesenteric adenopathy. Fluoroscopic examination confirmed distal ileal transverse fold thickening. Isolation of enterobius vermicularis in stool and biopsy confirmed the diagnosis. enterobius should be included among the causes of eosinophilic ileocolitis. ( info) |
7/148. Granulomatous osteonecrosis in Crohn's disease. A 25-year-old white woman was diagnosed with Crohn's disease involving the small and large intestines. She had a complex clinical course that required treatment with multiple pharmacological agents, including intravenous, oral and rectal corticosteroids. She also received parenteral nutrition with lipid emulsions. Finally, repeated intestinal resections and drainage of perianal abscesses were required. Her disease was complicated by gallstones, urolithiasis and hip pain. After osteonecrosis was diagnosed, joint replacements were performed. review of the pathological sections from the resected hip, however, resulted in detection of granulomatous inflammation with multinucleated giant cells - the histological 'footprint' of Crohn's disease in the gastrointestinal tract. Because prior specialized perfusion fixation pathological studies of the intestine in Crohn's disease have shown that granulomas are located in the walls of blood vessels, a possible mechanism for the pathogenesis of osteonecrosis in Crohn's disease is chronic microvascular ischemia of bone. ( info) |
8/148. Primary Epstein-Barr virus-associated hodgkin disease of the ileum complicating crohn disease. We describe a case of primary hodgkin disease of the terminal ileum in a 38-year-old man with crohn disease of 24 years' duration. The infiltrate was located in an ulcerated fistula involving the terminal ileum and urinary bladder. reed-sternberg cells and their variants were characteristically positive for CD15, fascin, and CD30 and showed focal positivity for CD20. Epstein-Barr virus messenger rna was also detected in the neoplastic cells. Staging revealed no evidence of other lymph node or organ involvement. Although rare, primary gastrointestinal hodgkin disease arising in the setting of crohn disease may have a stronger association with Epstein-Barr virus infection than conventional hodgkin disease. ( info) |
9/148. Necrotizing ileitis caused by cytomegalovirus in patient with systemic lupus erythematosus: case report. We report a systemic lupus erythematosus (SLE) patient with necrotizing ileitis diagnosed at a tertially care centre in thailand. The patient was surgically explored because peritonitis was suspected and segmental gangrenous and perforation of the terminal iliem were found. The pathological finding was necrotizing ileitis with appearance of cytomegalic intranuclear inclusion body. The presence of cytomegalovirus (CMV) infection in tissue was confirmed by CMV-dna detection using polymerase chain reaction and ELISA probe hybridization method. The hemoculture and peritoneal fluid culture results revealed no pathogenic organisms. Postoperatively, the clinical course of the patient deteriorated and she developed hypotension. Vasopressive drugs were administered without clinical improvement. She expired on day 5 postoperation. Regarding CMV infection, the organism involves the small bowel in only 4.3 per cent of all CMV infections of the gastrointestinal tract. Isolated cases of ileal perforation due to CMV infection have never been reported in a SLE patient. Thus, chronic right lower abdominal pain, fever with or without diarrhea in immunocompromised patients should cause clinicians to consider CMV ileitis in the differential diagnosis. Immediate surgical resection and prompt antiviral therapy lead to successful treatment. ( info) |
10/148. Non specific jejunoileitis--a report of 8 cases. Nonspecific jejuno-ileitis is a nonocclusive, necrotizing inflammation of the small intestine. We treated 8 patients of jejuno-ileitis in a short span of 8 months. Their mean age was 8.6 years. All had acute pain in abdomen and most had hematochezia. radiology was helpful only in diagnosis of complications of the disease. Four patients responded to conservative management; the other 4 required surgery--laparotomy and lavage in 2, and multiple laparotomies with resections in 2. One patient died due to chronic malnutrition and metabolic complications. Bowel histology was suggestive of resolving vasculitis in one patient and chronic inflammation in another patient. ( info) |