Clinical and pathological features of benign ileocecal ulcerative lesions discovered by ileocolonoscopy: analysis of 31 cases

Abstract

To investigate the clinical and pathological features of benign ileocecal ulcerative lesions proven by ileo-colonoscopy. The clinical data of 31 patients, 17 males and 14 females, aged (47 +/- 17) (17 - 76) with distal ileal ulcers and/or ulcers of ileocecal valve, > or = 2 mm in diameter, confirmed by colonoscopy were analyzed. The clinical manifestations included abdominal pain, lower right abdominal pain, diarrhea, constipation, hematochezia, fever, and body weight loss. Abdominal pain was found in 20 patients (64.5%) and lower right abdominal pain in 6 (19.4%). 20 patients had the ulcers 0.2 - 1.0 cm in diameter and the ulcers of 11 patients were larger than 1.0 cm. The sites of ulcers included ileocecal valve (17 cases), anastomotic stoma after resection of ileocecal valve (3 cases), distal ileum (7 cases), and both ileocecal valve and distal ileum (4 cases). Single ulcer was seen in 17 patients and multiple in 14. The ulcers were sharply demarcated,without remarkable inflammation around or between the ulcers. Histopathological findings were mostly unspecific, such as chronic inflammation, active inflammation, ulceration, eosinophil infiltration, inflammatory granulation, granuloma, and thickness of vessel wall. Mostly, the causes of ulcer were of unknown origin (14 cases), especially for those of small size (12 cases). 10 cases (32.3%) were diagnosed as Crohn's disease. The other diagnoses were intestinal tuberculosis, ischemia, Behcet's disease, AIDS, and NSAIDs-associated ulcers. Most patients with benign ileocecal ulcers complain of abdominal pain, but lower right abdominal pain is not always present. The pathological findings are mostly not specific, but sometimes are critical for the diagnosis. The etiology was difficult to be confirmed and all the clinical data should be reviewed carefully.