Ileocolitis

In a small study ciprofloxacin was shown to be effective in association with standard treatment in patients with resistant disease [40], The results of this study were challenged by a controlled study in which ciprofloxacin (1 g/day) was associated with budesonide (9 mg/day) in ileocolic active CD. No difference was found compared to placebo, but surprisingly the overall response in both groups was lower than that reported in previous studies with budesonide [41],... 

Mahmud N, Kamm MA, Dupas JL, Jewell DP, O Morain CA, Weir DG, Kelleher D. Olsalazine is not superior to placebo in maintaining remission of inactive Crohn s cohtis and ileocolitis a double bhnd, parallel, randomised, multicentre study. Gut 2001 49(4) 552-6. 

In contrast to results obtained in rat aortic preparations, constriction of ileocolic artery produced in response to EGF was blocked by indomethacin, suggest-... 

Cholestyramine can be used to prevent bile salt induced colonic secretion in patients who have undergone limited ileocolic resections. Anticholinergic agents (dicyclomine hydrochloride, etc. see Chapter 7) are used to reduce abdominal cramps, pain, and rectal urgency. As with the antidiarrheal agents, they are contraindicated in severe disease or when obstruction is suspected. Care should be taken to dijferentiate exacerbation ofIBDfrom symptoms that may be related to coexistent functional bowel disease (see Chapter 37). 

Riebel et al. 1993 Wang and Liu 1988). Because deep penetration of the ultrasound beam is not necessary in small children, a high-resolution transducer (5-10 MHz) can be used to improve the definition of the image. The majority of intussusceptions (i.e. the ileocolic type) occur in the... 

Patients can be asymptomatic of the upper gastrointestinal tract involvement and can present with features of distal ileocolic Crohn disease (crampy abdominal pain, diarrhea) or they can present with weight loss, epigastric pain, recurrent vomiting or hematemesis and melena (Griffiths et al. 1989). 

In half of the patients with complaints dinical signs manifest in the first 2 years of life. Ulceration occurs only in those that contain ectopic gastric mucosa and thus is rare, but can cause occult fecal blood or frank blood in stool and anemia. Adhesions and formation of scar tissue can lead to obstructive ileus. The diverticulum can act as a lead point for ileocolic or ileoileal intussusception. 

A tenacious intestinal residue, enlarged lymphoid follicles or a distended appendix may serve as a lead point for an intussusception. It is seen in only 1% of CF patients. The intussusception is usually ileocolic. 

Intussusception occurs when a length of bowel, the intussusceptum , prolapses and invaginates (or telescopes) intoanadjacentsegment, the intussusdpiens . Four types of intussusception are described ileocolic ileo-ileocolic colocolic and ileoileal. Ileocolic is the most frequent and occurs in 90% of cases. 

Infectious ileocolitis Lymphadenitis mesenterica Invagination Volvulus... 

Puylaert JB, Lalisang RI, van der Werf SD, Doornbos L (1988) Campylobacter ileocolitis mimicking acute appendicitis differentiation with graded-compression US. Radiology 166 737-740... 

It has been widely shown that ultrasound may reveal a high incidence of infectious ileocecitis in patients with acute right lower quadrant pain suspicious for appendicitis (Puylaert et al. 1988, 1989, 1997 Tarantino et al. 2003). Sonography may also reveal the features of the bowel wall useful in the differential diagnosis between infectious ileocolitis, Crohn s disease and appendicitis (Table 11.1). 

Gerlock AJ Jr., Muhletaler CA, Berger JL, Halter SA, O Leary JP, Avant GR (1981) Infarction after embolization of the ileocolic artery. Cardiovasc Intervent Radiol 4 202-205... 

A.H. l6 years M Granulomatous ileocolitis 8 Nausea,vomiting RUQ, tenderness Abnormal... 

M.B. 18 years M Granulomatous ileocolitis 22 Nausea Hepatomegaly Abnormal... 

M.P. 21 years F Granulomatous ileocolitis 11 Nausea None Abnormal... 

L.G., an 18 year old with granulomatous ileocolitis treated for 14 days with parenteral nutrition had a percutaneous menghini needle liver biopsy after clinical and chemical abnormalities suggested early hepatic disease. Fig. 2 represents a high power view of the biopsy specimen showing evidence of a focal round cell infiltrate with mild to moderate steatosis. 

Since one could not exclude the possibility that the findings in this teenager were not related to the mild focal abnormalities often seen in granulomatous ileocolitis, two subsequent patients (M.P. and I.W.) with this latter disease and in whom this treatment modality appeared indicated were subjected to a percutaneous liver biopsy prior to the initiation of parenteral nutrition. In both instances abnormal hepatic parenchyma was appreciated. Fig. 3a demonstrates the focal inflammatory cell response in M.P. Repeat biopsies of both patients after several weeks of parenteral nutrition revealed a more severe degree of these same findings. (Fig. 3b). 

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