Regional Enteritis Research Articles

Porcine intestinal adenomatosis: a possible relationship with necrotic enteritis, regional ileitis and proliferative haemorrhagic enteropathy.

Necrotic enteritis and regional ileitis are recognised causes of sporadic death in pigs. In both conditions, the intestinal mucosa harbours the bacterium, Campylobacter sputorum subsp mucosalis, which was first associated with procine intestinal adenomatosis.

Ascorbic acid deficiency in clinical disease including regional enteritis.

Ascorbic acid deficiency in clinical disease including regional enteritis.

Carcinoma complicating Crohn's disease: Report of seven cases and review of the literature

Seven cases of adenocarcinoma complicating Crohn's disease are reviewed. In three of the patients, small bowel cancers developed in association with regional enteritis. In four patients, carcinoma of the colon was superimposed on Crohn's colitis. In two of these, the adenocarcinoma infiltrated chronic colocutaneous fistulas. Review of the literature shows an increasing number of reports of carcinoma complicating Crohn's disease, with a total of 36 cases of small bowel cancer and 30 cases of colon cancer previously reported. The significance of these and our own cases is discussed. The possibility of carcinoma must be kept in mind by clinicians following patients with Crohn's disease. Adenocarcinoma complicating Crohn's disease occurs at a younger age, on the average, and in areas similar to the distribution of Crohn's disease rather than the usual distribution of the cancer. Preoperative diagnosis is difficult, but changes in the nature of chronic fistulas should be investigated.

Intestinal anisakiasis: First case report from North America

The first case of intestinal anisakiasis In North America is described. This parasitic disease is recognized as a public health hazard in Japan and Europe. Man becomes infected with a larval form of the nematode Anisakis by consuming raw or undercooked fish containing the parasite. Typically, patients present with acute abdominal syndromes. Clinical and roentgenographic features may cause confusion with regional enteritis. Histologically, a striking eosinophilic granulomatous reaction occurs. Anisakiasis is most effectively prevented by discouraging the consumption of raw fish.

Voodoo in the general hospital. A case of hexing and regional enteritis

Voodoo in the general hospital. A case of hexing and regional enteritis

Voodoo in the General Hospital

We have observed the case of a hexed patient that emphasizes the interplay between modern medical practice and the influence of a supernatural voodoo subculture. Psychosocial stresses involved in the patient's illness (regional enteritis) added to the complexity of the clinical problem. The presence of ambivalence in the patient and her mother concerning their systems of belief, and their unwillingness to accept totally the treatment modalities of either modern medicine or voodoo, probably prevented the patient's predicted death.

Clinical Manifestations of Crohn's Disease in Children and Adolescents

Crohn's disease (regional enteritis) is a chronic disorder which usually appears in adolescence or early adulthood.1-8 The average age of onset reported in the adult literature is 27 years.9 Although it has not been reported frequently in children, Van Patter et al., found that 14% of 600 patients observed at the Mayo Clinic had an onset of symptoms occurring before the age of 15.10 Rogers et al.,11 utilizing a computerized analysis of their files, found that 21% of 489 patients with the diagnosis of Crohn's disease had the onset before age 15. In fact, the first patient that attracted Dr. Crohn's attention to this entity was a 16-year-old boy.12 Among the patients in the 7 to 15-year-age range at the Mount Sinai Hospital in New York, the maximum incidence was at 10 to 14 years of age.5 The current communication summarizes the clinical features of 58 patients with Crohn's disease of the small intestine and/or of the colon whose disease appeared before they were 15 years of age and emphasizes the prominence of the extra-intestinal manifestations. The mode of presentation of these younger patients was often such that the clinician's attention was diverted from the gastrointestinal tract. PATIENTS STUDIED During a 20-year period (1952 to 1972) at the Johns Hopkins Hospital, 376 patients were discharged with the diagnosis of regional enteritis or Crohn's disease. Forty-eight of them, or 12.7%, were under the age of 15. The diagnosis was based on pathological and/or roentgenographic cnteria. The study group included these 48 patients plus 10 others seen in the outpatient department or at other Baltimore hospitals (Sinai Hospital and the Greater Baltimore Medical Center).

Transient bacteremia associated with barium enema.

A group of 175 patients had barium enema. Pour-plate blood cultures were obtained immediately before and after the procedure and 5, 10, 15, and 30 minutes later. Bacteremia was demonstrable in 20 (11.4%) patients. In some, blood cultures were positive for as long as 15 minutes after barium enema; all were negative at 30 minutes. Among the bacteria associated with the 20 episodes of bacteremia were Escherichia coli, Klebsiella, enterococci, Proteus morganii, Bacteroides, and Veillonella. The incidence of bacteremia among patients with ulcerative colitis, regional enteritis, rectal polyps, colonic or rectal carcinoma, nonspecific diarrhea, or other lower intestinal tract disorders was not much different from patients free of rectosigmoid disease. The results of this study suggest that a history of recent barium enema may be important in patients who have endocarditis.

Amyloidosis and granulomatous ileocolitis. Regression after surgical removal of the involved bowel.

AMYLOIDOSIS associated with granulomatous bowel disease was reported in 1949 by Cohen and Fishman.1 Since then, 19 cases have been noted in the literature.2 Werther et al.3 found five cases of amyloidosis among 17 autopsied cases of regional enteritis. The lack of effective therapy for amyloidosis prompted them to propose that "when there is clinical evidence that amyloidosis has complicated regional enteritis, indication exists for surgical excision of the involved gut." They postulated that treatment of the primary granulomatous disease might alter the course of secondary amyloidosis: such an effect has been observed in amyloidosis associated with tuberculosis,4 chronic osteomyelitis, . . .

Regional enteritis of the duodenum.

Regional enteritis involves the duodenum more commonly than has been suspected.The demonstration of tubular narrowing of the antrum, pylorus, duodenal bulb, and second portion of duodenum is almost pathognomonic of the disease.Any inflammatory change of the duodenal loop in the absence of clinical pancreatitis warrants consideration of the diagnosis of regional enteritis and complete evaluation of the gastrointestinal tract. Patients with duodenal involvement will usually have the more easily recognizable changes in the small bowel and/or colon.

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.

Transient neurogenic bladder secondary to presacral abscess: Association with regional ileitis

Presacral abscess secondary to regional enteritis is rare and to our knowledge has not been previously reported as a cause of transient neurogenic bladder. This possible complication should be kept in mind in the evaluation of the genitourinary tract of patients with known regional enteritis. Because of the frequency of genitourinary eomplications associated with regional enteritis, preoperative evaluation of these patients should include excretory urography.

Fundamentals of Colon Surgery

This book aims to teach the students and residents general principles on the surgical management of diseases of the colon and rectum. Each chapter covers a major disease category—acute inflammation, ulcerative colitis, granulomatous disease, ischemic lesions, problems of fixation, benign and malignant tumors, and lower rectal and anal lesions. Aspects of anatomy, pathophysiology, and medical and surgical management principles are given. The book is written in an easily readable fashion, with very few specific data or statistics cited. The illustrations are superb; only two depict surgical technique. The reference lists, few in number and intended to offer only a starting point for the student, are not keyed in the text. Thus, the reader could not find out which article to read if he has a specific question in mind, eg, where to learn more about the role of radiation therapy in treating regional enteritis (p 107). However, this book fulfills

Radiologic Features of Diagnostic Importance

ADENOCARCINOMA of the duodenum or small bowel is a rare lesion. Peripapillary carcinomas are usually polypoid, ulcerated, nonobstructive, and immediately adjacent to the papilla of Vater. In the remainder of the duodenum, primary carcinoma is difficult to distinguish from metastatic disease or extension of tumor from the pancreas. In the mesenteric small bowel, primary carcinoma occurs more frequently in the jejunum than in the ileum. The roentgenographic findings are usually a short, fairly sharply demarcated filling defect associated with an eccentric and irregular channel and with overhanging edges. The mucosa is ulcerated and partial obstruction is common. 1 In recent years, a number of cases of adenocarcinoma of the small bowel have been reported in association with long-standing regional enteritis or in surgically excluded loops. 2 The diagnosis is very difficult to establish preoperatively because the presence of multiple strictures with intervening segments of dilated bowel obscures the associated malignant

Asymptomatic regional ileitis manifest as fever, hepatic disease, and splenomegaly: report of a case.

This case of regional ileitis demonstrates the need and practical value of considering potential visceral and systemic disease involvement in a patient with negligible gastrointestinal symptoms. Regional ileitis, alone, may be responsible for hepatosplenomegaly, high temperature, and hepatic dysfunction. The age of our patient, duration of disease and lack of gastrointestinal symptoms all tend to preclude the possibility of carcinoma of the small intestine.

Ascorbic Acid Deficiency and Fistula Formation in Regional Enteritis

Ascorbic acid, as measured in leukocytes and platelets and in serum, was significantly decreased in patients with regional enteritis compared to normal subjects. This was related, at least in part, to low intake of ascorbate in patients with ileitis. Patients taking supplemental vitamin C had normal leukocyte ascorbic acid, while serum ascorbic acid remained low. Ascorbate concentration was measured in ileal tissue obtained at surgery and there was an excellent correlation with leukocyte ascorbic acid. Patients with ileitis and fistulous tracts were noted to have significantly lower ileal and blood ascorbate level than patients without fistulae. It is suggested that fistula formation in ileitis may be, in part, related to local ascorbate deficiency.

Acquired hyperoxaluria with regional enteritis after ileal resection : J. Q. Stauffer, H. Humphreys, and G. J. Weir ( 79: 383, 1973)

Acquired hyperoxaluria with regional enteritis after ileal resection : J. Q. Stauffer, H. Humphreys, and G. J. Weir ( 79: 383, 1973)

The energy crisis in surgical patients.

Even though those exact words were not then used, the terms crisis and conservation of resources occupied the attention of surgeons long before the Middle East War, the Arab oil embargo, offshore drilling, and the Alaskan pipeline. The wasted, debilitated patient with a resectable neoplasm, the malabsorbing, toxic sufferer with regional enteritis receiving large doses of steroids, the massively burned patient, and the postoperative one with peritonitis and a small bowel fistula are all threatened by the energy requirements of the metabolic pool. Systemic metabolic needs in such persons are often increased and so erode lean body mass or muscle. Failure of the skeletal muscle system due to metabolic depletion is as fatal, if not as dramatic or evident, as cardiac, hepatic, renal, or central nervous system failure. It results in the inability to breathe adequately, to cough, to clear secretions, to maintain alveolar inflation, and to move about

Ankylosing spondylitis and regional enteritis.

A review of 200 randomly selected cases of regional enteritis revealed 6 cases of overt ankylosing spondylitis and 14 others with abnormal sacroiliac joints. Sex distribution was equal in both groups. In 14 of the cases of spondylitis, the disease was limited to the small bowel, indicating no correlation with colonic involvement.

Neoplasms of the small bowel.

Small bowel tumors are unusual lesions exhibiting nonspecific clinical features often diagnosed at an advanced stage. In the cases studied at the Hospital of the University of Pennsylvania nearly all the 32 patients with malignancies were symptomatic whereas in the 34 patients with benign lesions the condition was discovered as an incidental finding in about half of the patients. Weight loss, palpable mass or anemia usually indicated malignancy. Small bowel radiography was the most useful diagnostic aid in the present series. While the etiology of these lesions is unknown, villous adenomas probably bear a relationship to carcinoma. The association between chronic regional enteritis and small bowel tumors is unestablished but suggestive. An analysis of reported series reveals a disproportionate incidence of additional primary tumors in patients with small bowel neoplasms. Surgical extirpation is indicated for curative treatment. In the present series, resection in hope of cure was carried out in 25 of 32 malignant tumors resulting in eight five-year survivals. One of these latter lived nine years with disseminated malignant carcinoid reflecting the occasional indolent course of this tumor.