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PubMed1999

[Brucellosis presenting as acute abdomen].

Usually symptoms of brucellosis are nonspecific and characterized by a wide range of complaints. Although the disease in Israel is almost exclusively food borne (caused by Brucella melitensis in unpasteurized goat milk products) so the main route of infection is the gastrointestinal tract, but gastrointestinal complications are rare, and only sporadic cases of ileitis or colitis have been described. We present a 43-year-old woman with an acute abdomen, probably due to diverticulitis. It was diagnosed only after blood cultures were positive for Brucella melitensis. We believe that its protean manifestations should be considered in addition to the other bizarre presentations of this disease, important in our region.

Abdomen, Acute↗
PubMed1985

Extraintestinal cancers in inflammatory bowel disease.

The case histories of 1961 patients with inflammatory bowel disease (IBD), 1227 with Crohn's disease (CD) and 734 with ulcerative colitis (UC), have been studied for the incidence of extraintestinal malignant neoplasms. There were 54 extraintestinal cancers in 51 patients: 28 patients with CD and 23 with UC; 25 men and 26 women. There were 9 breast, 7 skin, 15 reticuloendothelial, 11 genitourinary, 3 lung, 3 perianal, 2 pancreatic islet cell, and several miscellaneous cancers. The number of patient-years from the onset of disease to the last date of follow-up was calculated for men and women with each form of IBD. The observed number (O) of neoplasms was recorded. The expected number (E) of neoplasms was derived from the Department of Health, Education, and Welfare (DHEW) incidence figures for the same neoplasms that occurred in a standard age- and sex-matched population. The O/E ratio was then calculated for each type of cancer as well as for the entire series. There were no statistically significant increases in overall O/E ratios of extraintestinal cancers for either CD (0.76) or UC (1.32). On the other hand, several specific types of cancer did appear to occur with a frequency that was significantly greater than expected. These cancers were classified into two groups. The first group included reticuloendothelial neoplasms. There was an excess of leukemias in UC (P less than 0.005) and an excess of lymphomas in both UC and CD (P less than 0.005). The second group included three squamous cell cancers of the perianal region, an incidence 30 times greater than expected, and two squamous cell cancers of the vagina, also in excess of the expected number. Lymphoma, leukemia, and squamous cell cancers have been reported to occur in excess in immunosuppressed or irradiated patients. It may therefore be speculated that the apparently increased incidence of these neoplasms in the patients with ileitis and colitis might be related to immunologic deficiencies associated with IBD, to the long-term administration of steroids or other immunosuppressive medications that were given to most of the patients or, possibly, to increased exposure to ionizing radiation. The apparently increased incidence of perianal and vaginal cancers of the squamous variety might be a consequence of the combined effects of chronic inflammatory disease involving these areas and primary immune suppression.

Adult↗
PubMed1990

An epidemiologic study of inflammatory bowel disease in Rochester, New York. Hospital incidence.

The epidemiological understanding of inflammatory bowel disease has been limited by the referral bases of most inflammatory bowel disease studies. The Colitis-Ileitis Study Group of Rochester, N.Y., developed a community-wide, computerized cumulative registry of all inflammatory bowel disease patients hospitalized at the 8 community hospitals for 1973-86. Clinical data were abstracted from each of the 1651 identified hospital charts. All of these patients resided in Monroe County (city and suburbs) and the 5 contiguous counties (Genesee/Finger Lakes Region, population 1,030,640). Of the 1651 hospital patients identified in the study, 1358 resided in Monroe County (Rochester and its immediate suburbs, population 702,238). Incidence, defined as time of onset of symptoms of inflammatory bowel disease, rose from baseline rates in the 1930s to peak in 1980 (Crohn's disease = 50.29/10(5) per decade, ulcerative colitis = 35.12/10(5) per decade) and declined through 1986. For Crohn's disease, the age-specific incidence rates peaked in the 20-29-yr-old group in each of the 5 decades studied. Ulcerative colitis seems to occur at all ages and may have a bimodal distribution. There was a period effect, with the 1970s having the highest incidence of Crohn's disease and ulcerative colitis for each age group. However, the age-specific incidence rate for Crohn's disease showed a 40% decrease in the 1980s compared with the 1970s in the 10-39-yr-old group (p less than 0.001). The age-specific incidence rate for ulcerative colitis showed a 50% decrease in the 1980s compared with the 1970s in the 10-49-yr-old group (p less than 0.001).

Age Factors↗
PubMed1985

Crohn disease of the small intestine: diffuse mucosal granularity.

A diffuse granular mucosal pattern, produced by a reticular network of radiolucent foci 0.5 to 1 mm in diameter, was identified in 39 out of 46 consecutive patients with Crohn disease of the small intestine. Resected specimens demonstrated that this pattern represented wide, blunted villi with lymphocytic infiltration. Such a pattern was the only evidence of small bowel involvement in 17 cases. In 3 patients with the commonly recognized lesions, separate regions of diffuse granularity were seen. No such pattern was detected in normal patients. Demonstration of diffuse granularity may contribute to the diagnosis and management of Crohn disease.

Adult↗
PubMed1991

Intra-abdominal abscess in regional enteritis.

Intra-abdominal abscess (IAA) developed in 129 of 610 patients (21.2%) with Crohn's disease confined to the small bowel. The location of the abscess was intraperitoneal (IPA) in 109 (17.9%) and retroperitoneal (RPA) in 20 (3.3%). There was a marked preponderance of male patients in the retroperitoneal group (ratio, 18:2) (p less than 0.0001). All 129 patients were operated on. Thirteen of one hundred nine patients (12%) with IPA were reoperated on for recurrent abscess, and nine (8.2%) for other reasons. External fistula developed in 24 patients (22%) after simple incision and drainage. Four (3.7%) died; one from hepatitis, and three from sepsis 5, 14, and 90 days after surgery. Of the 20 patients with RPA, two (10%) were reoperated on for recurrent abscess and four (20%) for other reasons. External fistula developed in two patients (10%). There were no deaths in this group. A small number of patients with IAA complicating regional enteritis had persistent sepsis causing postoperative death, which is, however, six times lower than in our comparable series of Crohn's (ileo)colitis.

Abscess↗
PubMed1964

GASTRO-DUODENAL CROHN'S DISEASE.

Gastro-duodenal Crohn's disease is rare. Thirty-one previously reported cases are briefly reviewed; histological confirmation of the diagnosis was not always possible. Details are given of a patient with pyloro-duodenal involvement accompanied by terminal ileitis and appendicitis where surgical specimens were available for study. The differential diagnosis is considered from the clinical and pathological aspects.

Acute Disease↗
PubMed2003

Mouse models for the study of Crohn's disease.

Crohn's Disease (CD) is a chronic inflammatory bowel disease (IBD) that can affect any portion of the gastrointestinal tract and can cause significant morbidity. A variety of animal models of both acute and chronic intestinal inflammation have been developed to investigate disease pathogenesis and novel treatment modalities. These include chemically induced, genetically manipulated and immune-mediated models of gut inflammation, each of which possesses similarities to human IBD and offers unique advantages for studying specific aspects of disease pathogenesis. However, the majority of these models are characterized by colitis and, unlike human CD, do not involve the small intestine. More recently, murine models of chronic ileal inflammation have been characterized that spontaneously develop and closely resemble human CD with regard to disease location, histologic features and clinical response to therapy. Two mouse models of experimental ileitis will be discussed in this review: the TNF DeltaARE and SAMP1/YitFc strains. Studies using these new models might provide important insight into the pathogenesis of human CD and test the efficacy of potential therapies to treat this devastating disease.

3' Untranslated Regions↗
PubMed1989

Incidence and sonographic diagnosis of bacterial ileocaecitis masquerading as appendicitis.

533 consecutive patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish acute appendicitis from bacterial enteritis. In 61 (11.4%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region--enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of the appendix. In 41 of these a bacterial infection was confirmed: infection due to Yersinia enterocolitica in 21, Campylobacter jejuni in 15, Salmonella B in 3, Salmonella C in 1, and Yersinia pseudotuberculosis in 1. In the other 20 bacteriological tests were negative (10) or not done (10). Oral barium studies, done in 15 patients, showed thickening of the terminal ileum in all of them. Only 22 of the 61 patients had diarrhoea. Yersinia enteritis clinically simulated an appendiceal mass in 17 of 22 patients, 6 of the 61 patients underwent surgery, and in all of them the appendix removed was normal. The other 55 patients recovered with conservative treatment. In 26 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocaecitis) seems to be responsible for an appreciable number of unnecessary appendicetomies. It has characteristic sonographic features that distinguish it from appendicitis.

Adolescent↗
PubMed1987

Crohn's disease--a case report.

A case of rather typical Crohn's disease in a 10 year old girl is described. She had suffered from intractable abdominal pain, diarrhea and fever for 1 year. Eventual right hemicolectomy revealed diffuse involvement of terminal ileum, cecum and ascending colon by confluent ulcerations and transmural inflammation. Histologically there were numerous well developed non-caseating granulomas scattered transmurally and in regional lymph nodes. Deep penetrating ulcerations were characteristic. Acid fast staining failed to demonstrate any organism. The rarity of Crohn's disease in Korea and this occurrence in pediatric age prompted this report.

Child↗
PubMed1991

[Bacterial ileocecitis, a "new" disease].

786 patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish appendicitis from bacterial enteritis. 533 of these patients were described before. In 91 (11.6%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region-enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of an inflamed appendix. In 64 of these a bacterial infection was confirmed (Yersinia enterocolitica in 28, Campylobacter jejuni in 24, Salmonella enteritidis in 11, Yersinia pseudotuberculosis in one). In the other 27, bacteriological tests were negative (17) or not performed (10). Only 34 of 91 had diarrhoea. Six of the 91 patients underwent surgery, in all of them the removed appendix was normal. The other 85 patients recovered with conservative treatment. In 38 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocecitis) appears to be responsible for an appreciable number of unnecessary appendicectomies. It has characteristic sonographic features which distinguish it from appendicitis.

Adolescent↗
PubMed1993

[Appendicitis, pseudoappendicitis and Crohn's disease].

Abdominal pain which is a basic symptom of Crohn's disease was in a group of 53 patients treated in 1981-1982 at the Surgical Clinic of the Third Medical Faculty in Prague 10 the initial symptom in 73.3% of the patients. The inflammation was most frequently in the terminal ileum and in the ileocaecal region, in the authors' group in 49.0% and 30.2% resp. In 18 patients appendectomy was performed, incl. 10 where it was performed a long time before the development of the first complaints caused by Crohn's disease. In these patients the authors do not assume, because of the long symptom-free period, that there existed a direct relationship with Crohn's disease which developed later. In six patients during laparotomy performed on account of pain in the right hypogastrium acute terminal ileitis, the first stage of Crohn's disease, was detected. In two patients the initial finding was granulomatous appendicitis.

Adult↗
PubMed1980

Brown bowel syndrome in Crohn's disease.

We describe a patient with bowel lipofuscinosis developing subsequent to Crohn's disease of five-years' duration. Lipofuscin pigment was demonstrated in the perinuclear region of smooth muscle cells with the longitudinal and circular coats of the ileal muscularis propria but not in the muscularis mucosa. Electron microscopy showed lipofuscin pigment forming within degenerating mitochondria, confirming the "brown bowel" syndrome as a smooth muscle mitochondrial myopathy.

Aged↗
PubMed1975

Can regional enteritis resolve completely?

The clinical experiences with a few patients diagnosed as regional enteritis by x-ray and histological examination and treated as such during a period of 15-40 years, have furnished some interesting data. It appears that in some instances, regional enteritis may gradually resolve completely or "burn" itself out, while in others it may be asymptomatic for years only to reappear suddenly with marked abdominal symptoms. An asymptomatic course can occur without steroid therapy. Initial surgery may be "curative" in some for many years; in others for only a short time.

Adolescent↗
PubMed1977

[About the so-called ischemic-ulcerative innerwall lesion of the bowels proximal to intestinal stenoses (author's transl)].

The ischemic ulceration resp. the ischemic necrosis of the intestine's internal wall located proximal to an obstruction is a rare complication. At present this diagnosis is established by the radiologist alone. The knowledge of this disease--which is at the time being abscure in its origin--is of great importance to the surgeon, who has to try to resect both, the obstructes and the ischemic-ulcerative regions, in order to avoid insufficiency of the anastomosis postoperatively. The oral border of the alteration can be determined by a frozen section during the operation. In this connection the fatal complications of total necrosis of the large and small intestines resp. is demonstrated for the first time.

Aged↗
PubMed1987

Bowel cancer characteristics in patients with regional enteritis.

We report 10 carcinomas in 8 patients with regional enteritis. Five of the cancers were in the ileum, 4 in the right colon, and 1 in the rectum. The visualized small bowel cancers appeared as benign strictures in small bowel involved by regional enteritis. Most were poorly differentiated. The colon cancers had a more typical radiographic appearance of malignancy. In some patients with small bowel cancer the malignancy was discovered only on histologic evaluation; the malignant nature of the lesion was not appreciated by radiography or gross examination at surgery.

Adenocarcinoma↗
PubMed1984

[Enteral protein loss in regional enteritis of the terminal ileum: treatment by segmental resection of the small intestine].

A case report is given of a 37 year old patient who suffered from excessive intestinal protein losses caused by inflammatory changes of the terminal ileum. Conservative treatment improved neither hypoproteinemia nor weight loss. Finally surgical removal of the afflicted intestinal segment did lead to healing. This rare indication for surgical removal of an intestinal segment is discussed on the basis of literature reviewed.

Adult↗