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Results for “ILEITIS, REGIONAL”

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PubMed1989

The influence of small bowel contamination on the pathogenesis of bowel obstruction.

Altered motility of the intestine after laparotomy, adynamic bowel segments, blind bowel loops following bypass operations, or diverticula may cause pathological growth of intestinal microflora and thus lead to contaminated small bowel syndrome (CSBS). As a result of malabsorption in the jejunum and ileum, loss of weight, growth arrest, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia may occur. In addition to these, the acute symptoms of small bowel contamination, intestinal obstruction and secretory diarrhea, are less well known. A stenosis in the terminal ileum was experimentally created in Göttingen minipigs and the bacterial flora of the small bowel assessed by quantitative cultures. After 3 months the number of aerobic and anaerobic bacteria in the pre- and poststenotic region had increased by a factor of 10(2)-10(5). The acute form of CSBS was diagnosed by microbiological examination of gastric samples in 14 children. After the children were treated with orally and intravenously administered antibiotics, the symptoms disappeared within 12-36 h. Reoperations for small bowel obstruction can be avoided by conservative treatment of CSBS with antibiotics.

Bacterial Infections↗

PubMed1987

[A case of retrovesical abscess due to Crohn's disease].

A 29-year-old man was admitted with pain on urination and high grade fever-up. Mass was palpated above the right lobe of prostate. Cystoscopy revealed an edematous region in the upward to the right ureteral orifice. CT revealed the retrovesical mass in the same region. The surgical specimen obtained by transurethral resection showed severe inflammatory changes, but no malignancy was found. Antimicrobial chemotherapy had been continued, but the mass did not disappear on palpation and computed tomography and cystoscopy revealed pus-discharge from the center of the edematous region was found. An operation was performed under the diagnosis of retrovesical abscess. The terminal ileum had formed adhesion to the posterior bladder wall. Segmental resection of the ileum and partial resection of involved segment of the bladder were performed. The pathological diagnosis was Crohn's disease. Inflammation of ileum seemed to infiltrate the bladder wall and formed an abscess. After the operation symptoms disappeared.

Abscess↗

PubMed1996

Sarcoidosis and regional enteritis in two patients.

Both sarcoidosis and Crohn's disease (regional enteritis) are characterized by granuloma formation and they also have an unknown etiology. Only a few subjects with co-existing sarcoidosis and Crohn's disease have been reported in the literature. We report two cases who suffered from both disorders. In the two subjects Crohn's disease began first and the symptoms of sarcoidosis came later; four and sixteen years, respectively.

Adolescent↗

PubMed1991

[Bacterial ileocecitis: a "new" disease].

In cases of clinical suspicion of an acute appendicitis sonography uncovers another disease as the real cause of the symptoms in about one-quarter of such cases. Bacterial ileocaecitis is most frequently diagnosed (11.6% of N = 786). In special bacteriological stool cultures, Yersinia enterocolitica and Campylobacter jejuni were identified, whereas Salmonella enteritidis was a rarer finding. The typical sonographic manifestation of bacterial ileocaecitis compared against Crohn's disease of the ileocaecal region is described. These two diseases can be differentiated against each other by means of sonography; likewise, it is also possible to distinguish them from appendicitis. Since stool cultures--which are not always prepared if diarrhoea is only mild or completely absent--are received relatively late in acute cases, knowledge of the sonographic manifestation of bacterial ileo caecitis can help save many an unnecessary laparotomy.

Appendicitis↗

PubMed1980

[Pathology of Yersinia infections].

At the present time yersinioses have turned from a comparatively small problem of regional pathology into a global problem of interest for large circles of medical workers, specialists in different fields. The paper presents the main clinico-anatomic forms of yersiniosis and still scarce data on their pathology. These diseases, as a rule, have a benign course, their lethality not exceeding 0.04%. The importance of studying their pathology is emphasized because the correct diagnosis helps avoid serious errors in examining biopsy specimens.

Appendicitis↗

PubMed1975

Granulomatous disease of the intestinal tract (Crohn's disease).

In a landmark lecture on this disease, the author presents his experience with some 8,000 cases of regional enteritis and 4,000 of granulomatous colitis. The paper is divided into sections on the history, pathology, pathogenesis, roentgen findings, and course of the disease. The main thrust of the paper is the extensive roentgen analysis of granulomatous disease, with a discussion of differential diagnosis, especially from ulcerative colitis. Through the years, the author has been impressed with certain clinical and roentgen features of this malady (his Ten Principles of Crohn's Disease) which are carefully reviewed.

Colitis, Ulcerative↗

PubMed1980

[Ulcerative colitis and granulomatous enteritis (author's transl)].

Radical operative treatment of ulcerative colitis and regional granulomatous enteritis leads to satisfactory short-term results. The high mortality of one-stage proctocolectomy in the acute case can be markedly reduced by a staged operation. The same applies for surgery in toxic megacolon. Preservation of continence in ulcerative colitis is rarely possible without endangering long-term results. Chances of evading life-long ileostoma in granulomatous enteritis are very much better. The prominent ileostoma represents a great step forwards. Conservatively treated patients with ulcerative colitis are by no means free from the risk of dangerous complications. 10% had to undergo surgery in the end and only 36% were symptom-free according to their own evaluation. Out of patients with ulcerative colitis treated with procto-colectomy and ileostoma 75% were completely symptom-free. Patients with symptoms had not obtained a prominent ileostoma or it was unsuccessful. Acute ileitis should not be treated operatively. Surgical treatment of chronic granulomatous enteritis need seldom be urgently performed and should be carefully evaluated. Late mortality in operated patients occurs only in the young, in a small percentage due to relapse.

Colectomy↗

PubMed1993

Altered expression of cell adhesion molecules in uninvolved gut in inflammatory bowel disease.

Adhesion of circulating cells to vascular endothelium occurs in the early phase of inflammation, and is mediated by specific cell adhesion molecules. Many such adhesion molecules are increased in inflamed regions of ulcerative colitis (UC) and Crohn's disease (CD) but there is limited knowledge of their expression in the uninvolved gut, adjacent to inflammation. We investigated immunohistochemically the expression of platelet endothelial cell adhesion molecule-1 (PECAM-1), intercellular adhesion molecule-1 (ICAM-1) and lymphocyte function-associated antigen-1 (LFA-1) on resected specimens taken at a distance of 2-4 cm from the inflamed area and without histological signs of inflammation. Compared with normal gut, we found (i) a significant increase of PECAM-1-positive vessels in the mucosa of uninvolved UC (149.0 +/- 24.1 vessels/mm2 (mean +/- s.d.); normal colon = 123.1 +/- 21.6; P = 0.004); (ii) a significant decrease of ICAM-1-positive vessels in uninvolved CD (111.9 +/- 22.6 vessels/mm2; normal ileum = 136.9 +/- 27.6; P = 0.04); and (iii) a moderate but statistically insignificant increase of LFA-1-positive cells in the mucosa of uninvolved UC and Crohn's ileitis. This altered expression of cell adhesion molecules may contribute to the early lesion in inflammatory bowel disease and provide new therapeutic opportunities.

Adolescent↗

PubMed1976

Bile acid metabolism and plasma protein turnover in Crohn's disease.

Postprandial duodenal bile acids, intestinal protein loss, and albumin and IgG turnover were studied in 19 non-operated patients with Crohn's disease. A lesion of the terminal ileum was present in 18 of 19 patients, either alone or associated with regional colitis. Identical bile acid studies were made in a control group of 20 patients with chronic diarrhoea of undetermined origin. Duodenal bile acid concentration was decreased in 9 of 19 patients with Crohn's disease, and in 5 of 20 patients with unexplained diarrhoea. The glycine/taurine-ratio was increased in 8 of 17 patients with Crohn's disease, but in only one of the 20 control patients. Abnormal intestinal protein loss was present in 13 of 14 patients with Crohn's disease. The fractional catabolic rate of albumin and IgG was increased in all 17 cases of Crohn's disease studied, except the patient with no protein loss. A statistically significant and positive correlation was observed between glycine/taurine-ratio and fractional catabolic rate of both albumin and IgG. No patient with Crohn's disease harboured an abnormal bacterial flora in the proximal small intestine. It is concluded that, in the absence of abnormal bacterial flora in the proximal jejunum, the glycine/taurine-ratio is more valuable as an indicator of terminal ileopathy than postprandial duodenal bile acid concentration in nonoperated patients with terminal ileitis. Abnormal intestinal protein loss and increased catabolic rate of albumin and IgG are practically always present in active Crohn's disease and are strong evidence of an organic gastrointestinal lesion in patients with normal radiographic findings.

Adolescent↗

PubMedDate not supplied

Regional variation in the histological appearance of the small and large intestine of the rat following acute and chronic administration of Melo's Conquer Mixture.

The effect of acute and chronic administration of various doses of Melo's Conquer Mixture (MCM) on the histological appearance of the small and large intestine was investigated in albino Wistar rats. Obtained results show that at recommended therapeutic dose, MCM is able to evoke an acute inflammatory response, with infiltration of the mucosa and submucosa by neutrophils, lymphocytes and eosinophils. In addition, there was submucosal lymphoid follicle hyperplasia and increased mucus secreting cells. The severity of these changes were dependent more on prolonged administration than dose. These findings suggest strongly that MCM is a potential toxic agent. We therefore recommend further chemical analysis to identify the possible toxic agent(s) in this mixture.

Animals↗

PubMed1997

[Is Crohn's disease different in the elderly?].

We reviewed the records of 22 patients hospitalized at onset or first presentation of Crohn's disease after age 50. There were 12 females and 10 males, and the mean age was 64.5 years. The most common presenting symptoms were: abdominal pain, fever, diarrhea and weight loss. The disease was located in the small bowel in 14, in the ileo-colic region in 3 and in the colon in 5. The median interval from onset of symptoms until diagnosis was 42 months. 12 (54%) underwent surgery. All 5 patients with colonic disease were operated. 6 patients underwent small bowel resections, mostly terminal ileum, while 1 had resection of both terminal ileum and left colon. The recurrence rate was 70% in the medically treated and 50% in those operated. 1 patient died after surgery for Crohn's disease (4.5%), and 3 others died of unrelated causes. Compared to younger patients, the symptomatology, clinical course, need for and response to surgery, and its complications, did not differ in these older patients, but the recurrence rate seemed to be higher.

Aged↗

PubMed1991

[Arterial misplacement of a central venous catheter with a fatal cerebral embolism].

A 26-year-old woman came to hospital with an acute abdomen and a history of abdominal pain for about 6 months. She showed signs of peritonitis and ileus and underwent a laparotomy after initial diagnostic procedures. There was massive terminal ileitis with perforation and localized peritonitis. Resection of the affected bowel was performed over 5 1/2 h without surgical or anesthetic complications. Postoperatively several attempts were made to insert a venous catheter via the internal jugular vein, first on the right and then on the left side. The catheter was finally placed and was used for infusions, although there were some signs that indicated a possible arterial position. Neurological disturbances followed the end of anesthesia; 2 h later the catheter was removed because of arterial malpositioning diagnosed by a blood gas analysis. The patient developed brainstem and cerebellar infarctions and died 2 days later. The main postmortem finding was massive swelling and paleness of the cerebellum and brainstem with macroscopically unaffected supporting arteries. The other main arteries of the head and neck were also unremarkable, except for two healing punctures of the left common carotid artery. Further examination revealed an embolism at the top of the basilar artery. The source was macroscopically obscure; stereomicroscopic examination of the heart showed small dark spots behind one fold of the aortic valve caused by parietal thrombosis of the damaged endothelium. The tip of the misplaced catheter had entered this region and caused the lethal embolism.

Adult↗

PubMedDate not supplied

[The risk of extra-colonic extension in Crohn's colitis].

One hundred and two patients with Crohn's colitis present on average for 8 years, were studied retrospectively in order to determine whether or not a group of patients existed in whom the disease remained limited to the colon, and if such a group could be identified early on in the course of the disorder. At the time of the diagnosis of Crohn's disease, 34 patients had a concomitant anoperineal lesion, while 68 had disease affecting the colon only. In the latter, at the end of the follow-up period, the disease remained exclusively limited to the colon in 39 cases (57 p. cent). The actuarial rate of non-extra-colonic spread was 75, 40 and 35 p. cent at 5, 10 and 15 years respectively. Spread involved above all the anoperineal region (55 p. cent at 10 years), and less often the ileum (20 p. cent at 10 years). In patients monitored for at least 6 years, there was no significant difference between those in whom disease had spread and those in whom it remained limited to the colon, regarding the main initial clinical findings by history and examination, the same applying after the disease had been present for 3 years. These results would go against the existence of a specific entity of "Crohn's disease affecting the colon as an organ" and support the opinion that coloproctectomy with a pouch should be avoided in colitis due to Crohn's disease.

Actuarial Analysis↗

PubMed1976

[Clinical aspects of inflammatory diseases of the large bowel with reference to coloscopy (author's transl)].

Ulcerative colitis and regional colitis Crohn are the most frequent inflammatory diseases of the large bowel in Europe. Clinical differentiation of these disorders are difficult. Diarrhoe with bloody stools are predominant. In cases with Morbus Crohn anorectal fistulas and involvement of the terminal ileum are frequently found. In cases with ulcerative colitis anorectal fistulas are more rare but in this disease a carcinoma of the colon often develops, especially when the course is severe and the involvement of the colon is extended. Clinical symptoms, courses and complications of both diseases are described. In differential diagnoses endoscopic procedures especially coloscopy play an important role. In cases of ulcerative colitis about 90% the rectum is involved. Spontaneous haemorrhage of the colonic mucosa with edema and pseudopolyps are typical endoscopic findings. Most cases with Crohn's disease show flat and irregular ulcers within a normal mucosa. In later stage a "cobble stone" relief is demonstrable. Endoscopy and guided biopsy are not only important for differential diagnosis but also for treatment and prognosis.

Colitis, Ulcerative↗

PubMedDate not supplied

[Treatment of perianal Crohn's disease].

Perianal Crohn's disease (PACD) is defined as the presence of persistent lesions in the anal canal and perianal region in patients with Crohn's disease. The relative incidence of PACD in Crohn's disease patients ranges from 15 to 80% in the literature, depending on the accuracy of the clinical investigations and the clinical importance attributed to the lesions in the various study populations. The incidence is significantly higher if the intestinal disease is located in the colon-rectum rather than in the small bowel. We reviewed our experience in 105 patients with PACD, 32 of whom presenting rectal localisation of the primary disease. We observed 2 stenoses, 3 perirectal abscesses, 3 rectal ulcerations, 5 skin tags, 10 fissures and 77 fistulas. Two dilatations under narcosis, 2 intrarectal drainages of abscesses, 19 fistulotomies, 7 partial fistulotomies and insertion of loose setons, 47 loose setons and 4 anoperineal diversions were performed. The remaining patients received medical and topical treatments. After a median follow-up of 30 months, 90 patients (86%) showed a good response with improvement in functional scores, while 15 (14%) showed no improvement or a worsening requiring proctectomy in 13 cases. All patients submitted to proctectomy had rectal localization of the disease.

Adolescent↗

PubMedDate not supplied

Submucosal collecting venules: a reliable site for intestinal intravital microscopy in rats.

Under physiological conditions and after interventions such as ischemia/reperfusion, postcapillary mesenteric venules are most commonly used for in vivo assessment of intestinal microcirculation by intravital microscopy (IVM). In experimental models of gut inflammation, however, IVM was found to be hampered by postinflammatory tissue injury. In this study, postcapillary submucosal collecting venules located at the junction of mesentery and ileum are introduced and evaluated for IVM in a rat model of indomethacin-induced ileitis. The injection of indomethacin was followed by a significant increase in the number of sticking and rolling leukocytes. At the submucosal localization, rollers increased from 5.9 +/- 1.4/0.01 mm(2)/30 s to 34.8 +/- 13.4/0.01 mm(2)/30 s (p <.05), and at the mesentery from 8.0 +/- 2.1/0.01 mm(2)/30 s to 43.1 +/- 13.5/0.01 mm(2)/30 s (p <.05). The number of adherent leukocytes measured at the submucosal level went from 0.21 +/- 0.2/0.01 mm(2)/30 s up to 10.9 +/- 2.9/0.01 mm(2)/30 s (p <.05) and at the mesentery from 0.16 +/- 0.2/0.01 mm(2)/30 s to 15.4 +/- 3.4/0.01 mm(2)/30 s (p <.05). The macroscopic ranking showed an ulcer index of 4.93 +/- 0.76 in the indomethacin group versus 0 in the control group. We found that, despite severe inflammation, this site provided easy and reliable access for IVM. Therefore, we suggest this submucosal site for future studies of intestinal microcirculation in rat models of gut inflammation.

Animals↗