Cases reported "Ileitis"

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1/22. 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.
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2/22. Obstructive ileitis secondary to colon cancer: report of a case.

    We report a case of obstructive ileitis (OI) secondary to colon cancer. A 62-year-old man was hospitalized for abdominal pain and a feeling of fullness. Examinations revealed a mechanical ileus caused by an obstructing carcinomatous lesion of the cecum. He underwent laparotomy on the tenth hospital day, and a right hemicolectomy was carried out with resection of the distended and edematous ileum. The histopathologic diagnosis was adenocarcinoma in the cecum involving the ileocecal valve and nonspecific inflammatory change of the ileum, with mucosal necrosis and neutrophilic infiltration involving the subserosal layer. His postoperative course was uneventful. OI does not always show similar histological features to obstructive colitis; however, they are both important types of obstructing lesions, and their possibility must be kept in mind during colorectal cancer surgery.
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3/22. Uncommon case of a foreign body ingestion with consecutive small-bowel obstruction in a child.

    A 12-year-old boy with Lennox syndrome presented with an acute abdomen and a history of progressive abdominal pain and vomiting over 3 weeks. The uncommon finding in this case was a foreign body detected in a lower loop of the jejunum causing radiological and clinical signs of jejunitis/ileitis. The foreign body had to be removed surgically and turned out to be a hard (originally soft) plastic part of a towel rack.
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4/22. Acute jejunoileitis. A distinct entity?

    A 44-year-old man with acute jejunoileitis of unknown etiology developed small bowel obstruction. Intermittent abdominal pain, bloody diarrhea, ascites, and leukocytosis were prominent features. All stool cultures were negative. On steroid treatment, symptoms and radiographic features completely resolved. We suggest, in agreement with an earlier report, that acute jejunoileitis may be regarded as a distinct clinical entity.
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5/22. Simultaneous diagnosis of ulcerative jejunoileitis and coeliac disease in an elderly man.

    Ulcerative jejunoileitis (UJI) is a rare condition which usually develops in patients with established or simultaneously diagnosed coeliac disease (CD) and has been suggested to represent cryptic low-grade enteropathy-associated t-cell lymphoma (EATL). We report a case of a 78-year-old male patient with UJI and CD diagnosed at the same time. He presented with abdominal pain, diarrhoea and weight loss and had serological, endoscopical, radiological and histological findings compatible with the diagnoses of both UJI and CD. The possibility of EATL was carefully excluded. The patient exhibited significant symptomatic improvement with a gluten-free diet, probably indicating an early stage of disease despite his old age. In conclusion, this rather unusual case of an elderly patient presenting with UJI and CD without evidence of EATL supports the great heterogeneity of these diseases not only in their clinical presentation but even in their course and complications.
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6/22. Isolated cytomegalovirus ileitis detected by colonoscopy.

    cytomegalovirus infections in immunocompromised patients mimic graft-versus-host disease by causing abdominal pain, watery diarrhea, and protein-losing enteropathy. The cases of three bone marrow transplant patients with diarrheal illness and biopsy-proven graft-vs.-host disease are reported. Isolated cytomegalovirus enteritis was subsequently identified by endoscopic examination and biopsy of the terminal ileum. All three improved with the eventual institution of 9-(1,3-dihydroxy-2-propoxymethyl) guanine. Ileoscopy is important in addition to colonoscopy in bone marrow transplant patients with diarrhea if cytomegalovirus enteritis is to be identified and appropriately treated.
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7/22. Pathogenic escherichia coli: a new etiology for acute ileitis in children.

    Acute ileitis in children is frequently diagnosed at the time of laparotomy for acute abdominal pain and is usually due to inflammatory bowel disease, yersinia, or campylobacter infections. We report a case in which a pathogenic strain of escherichia coli was responsible for the disease. The diagnosis, microbiology, and epidemiology are discussed.
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8/22. A case of Behcet's disease with intestinal involvement due to Crohn's disease.

    A 15-yr-old, Arabic male presented with painful, recurrent, self-resolving oral and genital ulcers, erythema nodosum and uveitis. Behcet's disease was diagnosed. A few months later, he experienced anorexia, abdominal pain, diarrhea, and weight loss. Although all routine laboratory and radiologic investigations were negative, colonoscopy revealed the presence of serpiginous ulcers with pseudopolyps and inflamed intervening mucosa in the proximal half of the colon. Therapy with oral steroids was helpful, but the disease exacerbated a few months after prednisone was discontinued. Repeat evaluation showed similar endoscopic findings and, on colonic biopsy, noncaseating granulomas compatible with Crohn's disease were seen. Again, the patient responded well to oral steroids and sulfasalazine. We believe that gastrointestinal involvement in our patient is compatible with Crohn's disease and that screening tests to rule out chronic inflammatory bowel disease should be performed in the presence of gastrointestinal involvement in Behcet's disease. Behcet's disease may be a part of the spectrum of chronic inflammatory bowel disease.
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9/22. Eosinophilic enteritis--a recent north queensland experience.

    Thirty-three patients have been investigated in Townsville between 1983 and 1987 with eosinophilic enteritis. All were Caucasian and had been well prior to this illness. Twenty-six had similar presentations with episodic and transient abdominal pain often with features of small bowel obstruction. Four patients presented with pain and diarrhoea, two with chronic diarrhoea and one with recurrent melena. All patients at some stage during their illness developed high peripheral blood eosinophil counts, mean value 2096/mm3. Nine patients had laparotomies. The disease typically involved a short segment of ileum or jejunum with thickening and induration. The histology of the four resected specimens demonstrated a transmural inflammation with edema and an intense eosinophilic infiltrate. A solitary adult hookworm was identified in one patient adherent to the mucosa of the resected bowel. Each of the 19 patients treated with antihelminthic drugs responded promptly. Recovery was accompanied by a return to normal peripheral blood eosinophil counts. This paper reports an unusual form of eosinophilic enteritis thought due to a parasitic infection. The diagnosis should be considered in patients from North queensland presenting with abdominal pain and eosinophilia. laparotomy should be delayed pending a trial of conservative therapy with mebendazole.
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10/22. 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.
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