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Regional enteritis in a 41-year-old woman was localized on a 67Ga-citrate scan, appearing as a well-circumscribed abnormality in the pelvis simulating an abscess or a malignant neoplasm. Gallium-67-citrate scintigraphy is useful in localizing granulomatous inflammations including regional enteritis, and its use may be beneficial in evaluating the extent and the state of disease process.
Regional enteritis may be a protean disease, easily diagnosed when the common clinical presentation is noted. Occasionally, however, "atypical" features lead to the clinical suspicion of neoplastic disease. Four patients underwent angiographic evaluation in this clinical setting, all demonstrating similar changes in the mesenteric arteries. A serrated, "corkscrew" pattern was present and corresponded well to the perivascular fibrosis noted histologically. Recognition of this angiographic pattern may be important in differentiating neoplastic from inflammatory disease processes.
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Urological complications of regional enteritis occur frequently and may be clinically unsuspected. Radiographic findings include nephrolithiasis, characteristic stricture of the ureter, panvesiculitis, and enterovesical fistual. Less specific findings include renal amyloidosis and retroperitoneal abscesses. Mucosla nodularity of the bladder dome, even without gastrointestinal symptoms, should raise the possibility of regional enteritis. On the other hand, occult ureteral stenosis in patients with known regional enteritis may be present. For this reason, it is recommended that routine and periodic excretory urograms be a central part of the evaluation of the patient with regional enteritis.
Lymphoma and regional enteritis may demonstrate strikingly similar patterns in the small bowel. Fifty cases of regional enteritis and small-bowel lymphoma were reviewed. Of these, there were 12 cases of both diseases in which a confident radiographic distinction could not be made. Both diseases may narrow the terminal ileum, present as inflammatory processes, and demonstrate nodular patterns. Other similarities include aneurysmal dilatation, several types of ulceration, fistula formation, mesenteric masses, and involvement of the terminal ileum either alone or in association with skip areas. Clinical implications and the pathologic processes responsible for the radiographic similarity between these entities are discussed.
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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.
Lymphocytes from kindreds containing five sibling pairs affected with regional enteritis were typed to ascertain the association between histocompatibility leukocyte antigens (HLA)-A and -B and regional enteritis. Also, the frequency of HLA antigens in 22 patients with nonfamilial cases of regional enteritis was compared to the frequency in 402 normal blood donors. No HLA haplotype was found in more than one kindred, and no HLA antigen was more prevalent in nonfamilial cases of regional enteritis than in the normal population. In the five affected sibling pairs, four shared both haplotypes (HLA identical), and one shared one haplotype. Only one unaffected sibling shared two haplotypes with an affected proband. The high frequency of HLA identity in affected siblings and the low frequency of identity in unaffected siblings suggest linkage between the histocompatibility locus and the development of regional enteritis. There appears to be a genetic component in kindreds with regional enteritis.
Severe melena is a rare complication of acute regional enteritis. The hemorrhage is more severe when the large intestine is also involved. The difference betwee "real" acute regional enteritis and exacerbations of regional enteritis lies in their pathological appearance, development and complications.
Regional enteritis was diagnosed in an 11-year-old, spayed female German shepherd dog with a history of intermittent vomiting and anorexia. Segmental, transmural granulomatous enteritis involved the pylorus, jejunum, and ileum. The jejunal lesions were excised. The remaining lesions completely resolved subsequent to long-term prednisone and sulfasalazine therapy.
Three cases of regional enteritis (Crohn disease) with secondary involvement of the urinary bladder diagnosed by ultrasound are presented. The ability of ultrasound to simultaneously and noninvasively demonstrate the changes in bladder and adjacent bowel, unlike other radiologic or urologic investigations, is emphasized.
Two patients with relatively quiescent regional enteritis had liver abscesses caused by S MG-intermedius. The occurrence of two such cases in a single hospital in the space of a few weeks, while possibly coincidental, suggests that infections with this organism, particularly hepatic abscesses, may be more common in patients with regional enteritis than previously realized.
The present-day concepts concerning the surgical management of regional enteritis are reviewed and the multitude of problems that may arise in surgical treatment are discussed. The primary treatment of regional enteritis remains medical. Surgical intervention is necessary only for the complications of intractability, obstruction, fistula, abscess formation, anal and rectal complications, massive hemorrhage and perforation. To ensure the best possible results, medical treatment should continue after surgery. A perfect operation for this disease does not exist. Operations for regional enteritis can now be performed with a mortality rate of less than 2%, and although the recurrence rate following surgery averages approximately 30%, the disease is well controlled in the majority of patients with medical and/or surgical treatment.
An increased risk for regional enteritis patients of small bowel adenocarcinoma to develop has been suspected but unproved. We have analyzed 49 cases reported since 1957 and two additional ones of our own. These have been compared with a current group of small bowel adenocarcinomas not associated with regional enteritis. The Crohn-associated cancers differed from adenocarcinomas not associated with Crohn disease in that (1) mean age at cancer discovery was less (46 vs 64 years), (2) more cancers arose in the ileum (76% vs 27%), (3) diagnosis and cure were less successful, and (4) they occurred more frequently. The 32 cases reported in the past five years were compared with the expected 0.1 to 5 cases. Regional enteritis patients were found to have an increased risk for the development not only of small bowel adenocarcinoma, but one that is more occult and lethal than that in individuals wihtout Crohn disease.
This report is of a patient with long-term small bowel regional enteritis who presented with a perforation of an adenocarcinoma involving a diseased portion of ileum. Adenocarcinoma of the small bowel is rare. The incidence of small bowel adenocarcinoma may be higher in patients with regional enteritis, but a definite relationship cannot be established on the basis of data presently available. Small bowel adenocarcinoma in regional enteritis usually presents with obstructive symptoms.
A patient with liver abscess in association with regional enteritis is reported. Liver abscess should be suspected in patients with regional enteritis who present with fever, elevated serum alkaline phosphatase, liver tenderness, right upper quadrant pain or hepatomegaly.