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Ljungquist O, Poijes S, Sunnerhagen T, Bläckberg A. A population-based study of the appearances of enteric Campylobacter and non-typhoidal Salmonella infections on computed tomography. Ann Med 2024; 56:2356638. [PMID: 38775490 PMCID: PMC11123536 DOI: 10.1080/07853890.2024.2356638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Swift identification and diagnosis of gastrointestinal infections are crucial for prompt treatment, prevention of complications, and reduction of the risk of hospital transmission. The radiological appearance on computed tomography could potentially provide important clues to the etiology of gastrointestinal infections. We aimed to describe features based on computed tomography of patients diagnosed with Campylobacter, Salmonella or Shigella infections in South Sweden. METHODS This was a retrospective observational population-based cohort study conducted between 2019 and 2022 in Skåne, southern Sweden, a region populated by 1.4 million people. Using data from the Department of Clinical Microbiology combined with data from the Department of Radiology, we identified all patients who underwent computed tomography of the abdomen CTA two days before and up to seven days after sampling due to the suspicion of Campylobacter, Salmonella or Shigella during the study period. RESULTS A total of 215 CTAs scans performed on 213 patients during the study period were included in the study. The median age of included patients was 45 years (range 11-86 years), and 54% (114/213) of the patients were women. Of the 215 CTAs, 80% (n = 172) had been performed due to Campylobacter and 20% (n = 43) due to Salmonella enteritis. CTA was not performed for any individual diagnosed with Shigella during the study period. There were no statistically significant differences in the radiological presentation of Campylobacter and Salmonella infections. CONCLUSION The most common location of Campylobacter and Salmonella infections was the cecum, followed by the ascending colon. Enteric wall edema, contrast loading of the affected mucosa, and enteric fat stranding are typical features of both infections. The CTA characteristics of Campylobacter and Salmonella are similar, and cannot be used to reliably differentiate between different infectious etiologies.
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Affiliation(s)
- Oskar Ljungquist
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Sophie Poijes
- Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden
| | - Torgny Sunnerhagen
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Lund, Sweden
| | - Anna Bläckberg
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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2
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Kilincalp S, Mottacki N. A Shallow Large Ulcer on the Ileocecal Valve in a Young Man With Ulcerative Proctitis. Gastroenterology 2022; 164:e16-e18. [PMID: 36509155 DOI: 10.1053/j.gastro.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Serta Kilincalp
- Department of Gastroenterology, University of Gothenburg, Gothenburg, Sweden.
| | - Nima Mottacki
- Department of Gastroenterology, University of Gothenburg, Gothenburg, Sweden
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3
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Miyata E, Jimbo K, Kyodo R, Suzuki M, Kudo T, Shimizu T. Differentiation of Yersinia enterocolitica enteritis from other bacterial enteritides by ultrasonography: A single-center case-control study. Pediatr Neonatol 2022; 63:262-268. [PMID: 35277366 DOI: 10.1016/j.pedneo.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/15/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The diagnosis of Yersinia enterocolitica (Ye) enteritis is not easy because detection from stool culture is more difficult for Ye than for other bacterial enteritides. The establishment of characteristic ultrasonographic findings for Ye enteritis would help improve the detection rate of Ye enteritis along with performance of several cold cultures. This would facilitate appropriate selection of antibiotics based on antimicrobial susceptibility testing and contribute to a more accurate understanding of local public health. This study aimed to retrospectively compare ultrasonographic findings and clinical features between children with Ye enteritis and other bacterial enteritides. METHODS We identified patients treated for Ye enteritis (Ye group; n = 27) or other bacterial enteritides (Other enteritis group; n = 29) between 2014 and 2018. Ultrasonographic findings (including mean maximum diameter and mean major-minor axis ratio of ileocecal lymph nodes, wall thickness of the terminal ileum, and presence of a pericecal hyperechoic region), clinical symptoms, and laboratory findings at first visit were compared between groups. RESULTS No difference in mean maximum diameter of ileocecal lymph nodes was seen between groups. However, mean major-minor axis ratio of ileocecal lymph nodes was lower in the Ye group than in the Other enteritis group (p < 0.001). Presence of a pericecal hyperechoic region was more frequent in the Ye group than in the Other enteritis group (p < 0.001). The combined presence of a mean ileocecal lymph node major-minor axis ratio <1.51 and a pericecal hyperechoic region offered 100% sensitivity. CONCLUSION Characteristic ultrasonographic findings identified in this study may improve ultrasonographic differentiation of Y. enterocolitica enteritis from other bacterial enteritides.
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Affiliation(s)
- Eri Miyata
- Department of Pediatrics and Adolescent Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics and Adolescent Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Reiko Kyodo
- Department of Pediatrics and Adolescent Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mitsuyoshi Suzuki
- Department of Pediatrics and Adolescent Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics and Adolescent Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
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4
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Molina Gutiérrez MÁ, Pérez Vigara A, Martínez-Ojinaga Nodal E, Bueno Barriocanal M, López López R. Value of abdominal ultrasound for evaluation of acute infectious ileitis in children. An Pediatr (Barc) 2022; 96:360-361. [DOI: 10.1016/j.anpede.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022] Open
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5
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Miyazaki R, Sakurai T, Iwashita Y, Shimada M, Shibuya N, Akita Y, Miyashita H, Maruyama Y, Sawada R, Toyonaga T, Takakura K, Saruta M. Characteristics and Endoscopic Classification of Ulcerative Lesions Affecting the Ileocecal Valve. Dig Dis 2022; 40:239-245. [PMID: 34000716 DOI: 10.1159/000516975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to propose an endoscopic classification system for ulcerative lesions on the ileocecal valve and investigate its relevance to the underlying etiology. METHODS Among the 60,325 patients who underwent colonoscopy at our hospital from January 2006 to December 2018, patients with ulcerative lesions on the ileocecal valve were included. The following data were obtained using the hospital's medical records: sex, age, clinical diagnosis, laboratory data, and endoscopic and histological findings. Patients who have ulcerative colitis and who were not evaluated by histological examination were excluded. Ulcerative lesions on the ileocecal valve were classified into 3 groups according to their endoscopic appearance: small shallow ulcerative lesions without edematous change (group A), lateral spreading shallow ulcerative lesions with edematous change (group B), and deep deformed ulcerative lesions (group C). The association between this endoscopic classification and its clinical diagnosis, clinical course, and the interobserver reliability were evaluated. RESULTS Of 72 patients who were eligible for analysis, 18 were assigned to group A, 9 to group B, and 45 to group C. Infectious enteritis was mainly assigned to group A (group A, 12; group B, none; and group C, 6; p < 0.0001), inflammatory bowel disease was mainly assigned to group C (group A, none; group B, 5; and group C, 35; p < 0.0001), and malignant tumor was assigned to group C only. Interobserver reliability was extremely high among the 3 examining doctors (kappa value 0.7-0.8). CONCLUSION Endoscopic classification was divided into 3 groups for ulcerative lesions on the ileocecal valve, and this system could be beneficial for presuming their clinical diagnoses.
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Affiliation(s)
- Ryosuke Miyazaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiyuki Sakurai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Iwashita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Mariko Shimada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Shibuya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshihiro Akita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruna Miyashita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Maruyama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoichi Sawada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiko Toyonaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Takakura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Mohan V, Laska P, Meier A, Minotti B. Acute appendicitis with the presence of peristalsis seen in ultrasound. J Med Ultrasound 2022; 30:138-139. [PMID: 35832368 PMCID: PMC9272724 DOI: 10.4103/jmu.jmu_177_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/07/2021] [Accepted: 03/25/2021] [Indexed: 11/04/2022] Open
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7
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Hokama A, Kishimoto K, Fujita J. Campylobacter Enterocolitis: A Characteristic Shallow and Large Ulcer on the Ileocecal Valve. Chonnam Med J 2021; 57:156-157. [PMID: 34123746 PMCID: PMC8167440 DOI: 10.4068/cmj.2021.57.2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Akira Hokama
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuto Kishimoto
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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8
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Corral de la Calle M, Encinas de la Iglesia J. Ultrasonography in infectious and neoplastic diseases of the bowel and peritoneum. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Choi SY. Comparison of Clinical Characteristics According to the Existence of Secondary Appendicitis in Pediatric Acute Enterocolitis: A Single Center Study. Pediatr Gastroenterol Hepatol Nutr 2021; 24:127-134. [PMID: 33833968 PMCID: PMC8007837 DOI: 10.5223/pghn.2021.24.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/23/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE In patients with acute enterocolitis, radiologic findings are sometimes accompanied by secondary inflammation of the appendix. The purpose of this study was to evaluate the clinical features of acute enterocolitis with secondary inflammation of the appendix. METHODS Medical records from patients who underwent abdominal ultrasonography or computed tomography (CT) among those admitted for acute enterocolitis were retrospectively reviewed. Clinical features were compared by distinguishing patients with inflammation of the appendix from those without, based on their symptoms and laboratory findings. RESULTS Of the 165 patients, 12 (7.3%) had secondary inflammation of the appendix on ultrasonography and/or CT. Patients with secondary inflammation of the appendix were significantly older than those without (11.7 vs. 6.1 years, p=0.011) and more frequently had fever (83.3% vs. 49.0%, p=0.033), and high values of C-reactive protein (CRP) (5.38 vs. 0.32 mg/dL, p<0.001). The proportion of bacterial pathogens was higher in patients with secondary inflammation of the appendix (60% vs. 15.1%, p=0.004). CONCLUSION Patients with acute enterocolitis accompanied by secondary appendicitis more commonly have fever, higher CRP levels, higher bacterial pathogen detection rates, and longer hospital stays. Treatment equivalent to that of bacterial infection is required for patients with secondary appendicitis, and that their symptoms should be closely and continuously monitored and followed-up.
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Affiliation(s)
- So Yoon Choi
- Department of Pediatrics, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Korea.,Department of Pediatrics, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
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10
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Molina Gutiérrez MÁ, Pérez Vigara A, Martínez-Ojinaga Nodal E, Bueno Barriocanal M, López López R. [Value of abdominal ultrasound for evaluation of acute infectious ileitis in children]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00007-2. [PMID: 33610497 DOI: 10.1016/j.anpedi.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ana Pérez Vigara
- Servicio de Radiología Pediátrica. Hospital Universitario Infantil La Paz, Madrid, España
| | | | | | - Rosario López López
- Servicio de Urgencias Pediátricas. Hospital Universitario La Paz, Madrid, España
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11
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Corral de la Calle MÁ, Encinas de la Iglesia J. Ultrasonography in infectious and neoplastic diseases of the bowel and peritoneum. RADIOLOGIA 2021; 63:270-290. [PMID: 33608108 DOI: 10.1016/j.rx.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022]
Abstract
Ultrasonography is not the most cited imaging technique for the evaluation of infectious and neoplastic diseases of the gastrointestinal tract and the peritoneum, but it is often the initial technique used in the initial workup for nonspecific clinical syndromes. Despite its limitations, ultrasonography's strengths enable it to provide meaningful diagnostic information. To discuss the most important ultrasonographic, clinical, and epidemiological findings for infectious disease, we follow a topographical approach: stomach (Anisakis), proximal small bowel (Giardia lamblia, Strongyloides stercoralis, Mycobacterium avium-intracellulare complex, and Cryptosporidium), distal small bowel (Yersinia, Salmonella, and Campylobacter), terminal ileum and cecum (tuberculosis), right colon (Entamoeba histolytica), left colon (Shigella), sigmoid colon and rectum, pancolitis (Clostridium difficile, Cytomegalovirus, and Escherichia coli), and peritoneum. To discuss the ultrasonographic and clinical findings of the most common neoplastic diseases, we follow a nosological approach: polyploid lesions as precursors of tumors, carcinomas, neuroendocrine tumors, hematological tumors, mesenchymal tumors, and metastases. We briefly discuss tumors of the peritoneum and the use of ultrasonography to guide percutaneous biopsy procedures.
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12
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Revzin MV, Moshiri M, Bokhari J, Pellerito JS, Menias C. Sonographic assessment of infectious diseases of the gastrointestinal tract: from scanning to diagnosis. Abdom Radiol (NY) 2020; 45:261-292. [PMID: 31960117 DOI: 10.1007/s00261-019-02358-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sonography of the gastrointestinal (GI) tract is a practical, safe, inexpensive, and reproducible diagnostic tool for the evaluation, diagnosis, and follow-up of infectious bowel disease. The modality is rapidly gaining prominence among clinicians on a global scale. In the United States, however, ultrasound of the bowel remains underutilized primarily due to insufficient experience among radiologists and sonographers in performing sonographic bowel assessment. This lack of experience and knowledge results in misinterpretations, missed diagnoses, and underutilization of this modality in patients with acute abdomen, with the majority of GI pathology on sonography discovered incidentally. OBJECTIVES This article aims to demonstrate the characteristic sonographic findings associated with GI infectious processes as well as provide dedicated ultrasound protocols for evaluation of the GI tract. CONCLUSION This article serves a twofold purpose, raising awareness of the utility of this imaging modality within the radiology community and also providing practical teaching points for sonographic evaluation of infectious disorders of the GI tract.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA.
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Jamal Bokhari
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA
| | - John S Pellerito
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Christine Menias
- Radiology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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Granat N, Gabrieli S, Alpert EA. Point-of-Care Ultrasound to Diagnose Colitis in the Emergency Department: A Case Series and Review of the Literature. J Emerg Med 2019; 58:77-84. [PMID: 31672400 DOI: 10.1016/j.jemermed.2019.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/22/2019] [Accepted: 08/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colitis refers to an inflammatory process of the colon, composed of a variety of different etiologies including inflammatory bowel disease, infectious colitis, ischemic colitis, and allergic colitis. Usually, abdominal computed tomography (CT) is the gold standard in diagnosing the various forms of colitis. However, by the use of point-of-care ultrasound (POCUS), one may occasionally be able to discern wall thickening, pericolic fluid, and adjacent hyperechoic mesenteric fat. One may also see abscesses, fistulae, or ascites. CASE SERIES This is a series of 6 patients who had findings consistent with colitis seen on POCUS performed by an emergency physician. These were confirmed by abdominal CT with contrast. Early detection by POCUS was able to lead to a rapid diagnosis and to expedite treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The ability to detect findings of colitis by POCUS can be quickly learned by the emergency physician with a strong background in basic ultrasound. For many of the different subtypes of colitis, the initial treatment in the emergency department is the same: i.v. antibiotics, i.v. fluids, and "bowel rest" by maintaining the patient in nothing-by-mouth status. For the stable patient with high clinical suspicion of an infectious etiology of colitis, ultrasound can help confirm the diagnosis and rule out other etiologies. This may be especially important in certain populations such as children and young women, where one can avoid a significant amount of radiation being directed toward the pelvic area.
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Affiliation(s)
- Nadav Granat
- Department of Emergency Medicine, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Selma Gabrieli
- Department of Diagnostic Ultrasound, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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14
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Segal AW. Studies on patients establish Crohn's disease as a manifestation of impaired innate immunity. J Intern Med 2019; 286:373-388. [PMID: 31136040 DOI: 10.1111/joim.12945] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The fruitless search for the cause of Crohn's disease has been conducted for more than a century. Various theories, including autoimmunity, mycobacterial infection and aberrant response to food and other ingested materials, have been abandoned for lack of robust proof. This review will provide the evidence, obtained from patients with this condition, that the common predisposition to Crohn's is a failure of the acute inflammatory response to tissue damage. This acute inflammation normally attracts large numbers of neutrophil leucocytes which engulf and clear bacteria and autologous debris from the inflamed site. The underlying predisposition in Crohn's disease is unmasked by damage to the bowel mucosa, predominantly through infection, which allows faecal bowel contents access to the vulnerable tissues within. Consequent upon failure of the clearance of these infectious and antigenic intestinal contents, it becomes contained, leading to a chronic granulomatous inflammation, producing cytokine release, local tissue damage and systemic symptoms. Multiple molecular pathologies extending across the whole spectrum of the acute inflammatory and innate immune response lead to the common predisposition in which defective monocyte and macrophage function plays a central role. Family linkage and exome sequencing together with GWAS have identified some of the molecules involved, including receptors, molecules involved in vesicle trafficking, and effector cells. Current therapy is immunosuppressant, which controls the symptoms but accentuates the underlying problem, which can only logically be tackled by correcting the primary lesion/s by gene therapy or genome editing, or through the development of drugs that stimulate innate immunity.
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Affiliation(s)
- A W Segal
- From the, Division of Medicine, University College London, London, UK
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Agarwala R, Singh AK, Shah J, Mandavdhare HS, Sharma V. Ileocecal thickening: Clinical approach to a common problem. JGH OPEN 2019; 3:456-463. [PMID: 31832544 PMCID: PMC6891021 DOI: 10.1002/jgh3.12186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 12/22/2022]
Abstract
Ileocecal thickening (ICT) is a common finding on radiological imaging. It can be caused by a variety of inflammatory, infectious, or neoplastic conditions, and evaluating a patient of ICT can be a challenging task. Intestinal tuberculosis (ITB), Crohn's disease (CD), and adenocarcinoma are the most common causes. Enteric bacterial infections, cytomegalovirus, histoplasmosis, amebiasis, systemic vasculitis, lymphoma, etc. should be suspected in appropriate clinical settings. However, it could often be a spurious or nonspecific finding. A thickness of more than 3 mm in a normally distended small bowel is usually considered abnormal. Detailed evaluation of imaging of the site and extent of thickening; the degree and pattern of thickening; and the associated findings, such as degree of fat stranding, fibrofatty proliferation, adjacent lymph nodes, and solid organ involvement, should be performed. Ileocolonoscopy is an important tool for diagnosing and obtaining samples for tissue diagnosis. Histopathology is usually the gold standard for diagnosis, although—not uncommonly—findings could be nonspecific, and reaching a definitive diagnosis is difficult. As such, a systematic approach with the integration of clinical, biochemical, radiological, endoscopic, histological, and other laboratory tests is the key to reaching a diagnosis. In this article, we review the causes of ICT and present a clinical approach for the management of ICT.
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Affiliation(s)
- Roshan Agarwala
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Abhi K Singh
- Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Jimil Shah
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Harshal S Mandavdhare
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vishal Sharma
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
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16
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Acute Terminal Ileitis in Children: A Retrospective Study in a Pediatric Emergency Department. Pediatr Emerg Care 2019; 35:249-251. [PMID: 29596286 DOI: 10.1097/pec.0000000000001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aims to describe the clinical presentation and outcome of patients diagnosed with acute ileitis in our pediatric emergency department. METHODS We performed a retrospective study of all patients diagnosed with terminal ileitis by abdominal ultrasonography findings in our pediatric emergency department, over the years 2013 and 2014. Patients with previous diagnosis of inflammatory bowel disease (IBD) were excluded. Data collected were clinical, radiological, and laboratory data at diagnosis; outcome including hospitalization care; and outpatient follow-up in pediatric gastroenterology and/or primary care. RESULTS A total of 20 cases were retrieved and studied. All of them presented with abdominal pain, 65% located in the right lower quadrant. Leukocyte count, C-reactive protein, and fibrinogen levels (means, 12,889; 4/μL; 50.1 mg/L; and 575 mg/dL, respectively) were above normal range. Hemoglobin and platelet count were normal. A microbial cause of ileitis was found in 3 cases (Yersinia enterocolitica, Campylobacter jejuni, and Adenovirus). Nine patients were referred to a pediatric gastroenterology unit. No cases of IBD were found. CONCLUSIONS Acute ileitis is a rare and benign cause of abdominal pain in the pediatric emergency department. The main intervention on initial assessment is to rule out potentially severe causes of abdominal pain that could benefit of an emergency surgical procedure. In contrast with adults and adolescents, acute ileitis in children does not have a clear association with development of IBD.
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17
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Tang SJ, Wu R. Ilececum: A Comprehensive Review. Can J Gastroenterol Hepatol 2019; 2019:1451835. [PMID: 30854348 PMCID: PMC6378086 DOI: 10.1155/2019/1451835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/18/2018] [Accepted: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
For gastrointestinal endoscopists, the ileocecum is the finishing line during colonoscopy and it is identified by three endoscopic landmarks: terminal ileum, ileocecal valve, and the appendiceal orifice. Although ileal intubation is recommended during routine screening colonoscopy, it is not required in most cases of screening colonoscopy. Ileal intubation is indicated in certain circumstances such as suspected inflammatory bowel disease and GI bleeding. There is much pathology that can be observed within the ileocecum. Careful and systematic examination should be stressed during GI endoscopic training and practice. In this review, the authors demonstrate its anatomy, endoscopic findings, and pathologies.
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Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, USA
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Segal AW. The role of neutrophils in the pathogenesis of Crohn's disease. Eur J Clin Invest 2018; 48 Suppl 2:e12983. [PMID: 29931668 DOI: 10.1111/eci.12983] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022]
Abstract
Crohn's disease (CD) is caused by a trigger, almost certainly enteric infection by one of a multitude of organisms that allows faeces access to the tissues, at which stage the response of individuals predisposed to CD is abnormal. In CD the failure of acute inflammation results in the failure to recruit neutrophils to the inflammatory site, as a consequence of which the clearance of bacteria from the tissues is defective. The retained faecal products result in the characteristic chronic granulomatous inflammation and adaptive immune response. Impaired of digestion of bacteria and fungi by CGD neutrophils can result in a similar pathological and clinical picture. The neutrophils in CD are normal and their inadequate accumulation at sites of inflammation generally results from diminished secretion of proinflammatory cytokines by macrophages consequent upon disordered vesicle trafficking.
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Abstract
EDUCATION GAP Campylobacter is one of the 2 most common causes of foodborne illness in the United States. It most commonly occurs in children younger than 5 years of age. Campylobacter species can cause a wide range of syndromes, from asymptomatic infections to severe systemic infections. OBJECTIVES After completing this article, readers should be able to: 1. Recognize that Campylobacter is a common cause of foodborne illness in the United States and internationally. 2. Understand the indications for testing and the treatment of Campylobacter infection.
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Affiliation(s)
- Rebecca G Same
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
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Imaging of Small Bowel. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Perillo M, Becker-Weidman D, Bezuidenhout AF, Siewert B, Eisenberg RL. Infections of the Gastrointestinal Tract. Semin Roentgenol 2017; 52:63-72. [PMID: 28606310 DOI: 10.1053/j.ro.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michele Perillo
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - B Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Ronald L Eisenberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
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Chun P, Lim TJ, Hwang EH, Mun SW, Lee YJ, Park JH. Clinical Characteristics and Ultrasonographic Findings of Acute Bacterial Enterocolitis in Children. Pediatr Gastroenterol Hepatol Nutr 2017; 20:107-113. [PMID: 28730135 PMCID: PMC5517377 DOI: 10.5223/pghn.2017.20.2.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/03/2016] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study clarified the bacterial pathogens currently causing acute infectious enterocolitis (AIE) in children and evaluated the clinical characteristics and ultrasonographic findings according to the different pathogens. METHODS Medical records regarding age, sex, clinical symptoms, laboratory data, identified enteropathogens, ultrasonographic findings, treatment, and outcome of 34 patients who were diagnosed with AIE via stool examination using multiplex polymerase chain reaction (PCR) or culture, were retrospectively reviewed. RESULTS Twenty-four patients (70.6%) were male. The mean age of the patients was 8.5±6.2 (range, 1.1-17.1) years. Six bacterial pathogens were isolated: Salmonella species (spp.) (32.4%), Campylobacter spp. (20.6%), verotoxin-producing Escherichia coli (14.7%), Staphylococcus aureus (11.8%), Clostridium difficile (8.8%), and Shigella spp. (2.9%). Abdominal pain occurred in all patients regardless of pathogen. The patients infected with Salmonella were older than those infected with verotoxin-producing E. coli (p<0.05). C-reactive protein levels were higher in patients with Salmonella and Campylobacter infections than in those with verotoxin-producing E. coli infection (p<0.05), the other clinical and laboratory data were indistinguishable between pathogens. Ultrasonography demonstrated diverse involvement of bowel segments according to pathogen. Wall thickening of both the ileum and the entire colon was the most common lesion site regardless of pathogen. CONCLUSION Various bacterial agents cause AIE and the symptoms are diverse symptoms, however, all most children recovered spontaneously. Use of multiplex PCR on stool samples warrants improvement of its sensitivity for diagnosis of enteropathogenic bacteria. Ultrasonographic examination is useful for diagnosis of AIE; it can also detect the disease extent and severity.
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Affiliation(s)
- Peter Chun
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Taek Jin Lim
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Eun Ha Hwang
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Wook Mun
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Jae Hong Park
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
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Abstract
The cause of Crohn’s disease (CD) has posed a conundrum for at least a century. A large body of work coupled with recent technological advances in genome research have at last started to provide some of the answers. Initially this review seeks to explain and to differentiate between bowel inflammation in the primary immunodeficiencies that generally lead to very early onset diffuse bowel inflammation in humans and in animal models, and the real syndrome of CD. In the latter, a trigger, almost certainly enteric infection by one of a multitude of organisms, allows the faeces access to the tissues, at which stage the response of individuals predisposed to CD is abnormal. Direct investigation of patients’ inflammatory response together with genome-wide association studies (GWAS) and DNA sequencing indicate that in CD the failure of acute inflammation and the clearance of bacteria from the tissues, and from within cells, is defective. The retained faecal products result in the characteristic chronic granulomatous inflammation and adaptive immune response. In this review I will examine the contemporary evidence that has led to this understanding, and look for explanations for the recent dramatic increase in the incidence of this disease.
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Abstract
The cause of Crohn's disease (CD) has posed a conundrum for at least a century. A large body of work coupled with recent technological advances in genome research have at last started to provide some of the answers. Initially this review seeks to explain and to differentiate between bowel inflammation in the primary immunodeficiencies that generally lead to very early onset diffuse bowel inflammation in humans and in animal models, and the real syndrome of CD. In the latter, a trigger, almost certainly enteric infection by one of a multitude of organisms, allows the faeces access to the tissues, at which stage the response of individuals predisposed to CD is abnormal. Direct investigation of patients' inflammatory response together with genome-wide association studies (GWAS) and DNA sequencing indicate that in CD the failure of acute inflammation and the clearance of bacteria from the tissues, and from within cells, is defective. The retained faecal products result in the characteristic chronic granulomatous inflammation and adaptive immune response. In this review I will examine the contemporary evidence that has led to this understanding, and look for explanations for the recent dramatic increase in the incidence of this disease.
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Abstract
We present two cases of pediatric patients initially presenting with a clinical suspicion of acute appendicitis. In these cases, point-of-care ultrasonography was performed early in the patient's emergency department course, leading to alternate diagnoses. This article highlights a role for point-of-care ultrasound in the diagnoses of two alternate conditions that clinically mimic appendicitis: Meckel diverticulitis and acute ileocecitis. We offer a brief overview of terminology, relevant literature, and ultrasound scanning technique for the right-lower-quadrant point-of-care ultrasound evaluation.
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Abstract
Bowel ultrasound is cheap, relatively quick, allows dynamic evaluation of the bowel, has no radiation burden, is well tolerated by patients, and allows repeat imaging. Bowel ultrasound requires a systematic assessment of the entire bowel using high-frequency probes. In addition, hydrosonography and contrast-enhanced ultrasound may be performed. We present the normal sonographic appearances of large and small bowel and the sonographic appearances of acute appendicitis, Crohn's disease, celiac disease, intussusception, infectious enteritis, intestinal tuberculosis, small bowel ileus and obstruction, small bowel ischemia, and malignant tumors.
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Affiliation(s)
- Anita Wale
- Department of Radiology, St Georges Hospital, London, UK.
| | - James Pilcher
- Department of Radiology, St Georges Hospital, London, UK
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Reprogramming of Yersinia from virulent to persistent mode revealed by complex in vivo RNA-seq analysis. PLoS Pathog 2015; 11:e1004600. [PMID: 25590628 PMCID: PMC4295882 DOI: 10.1371/journal.ppat.1004600] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022] Open
Abstract
We recently found that Yersinia pseudotuberculosis can be used as a model of persistent bacterial infections. We performed in vivo RNA-seq of bacteria in small cecal tissue biopsies at early and persistent stages of infection to determine strategies associated with persistence. Comprehensive analysis of mixed RNA populations from infected tissues revealed that Y. pseudotuberculosis undergoes transcriptional reprogramming with drastic down-regulation of T3SS virulence genes during persistence when the pathogen resides within the cecum. At the persistent stage, the expression pattern in many respects resembles the pattern seen in vitro at 26oC, with for example, up-regulation of flagellar genes and invA. These findings are expected to have impact on future rationales to identify suitable bacterial targets for new antibiotics. Other genes that are up-regulated during persistence are genes involved in anaerobiosis, chemotaxis, and protection against oxidative and acidic stress, which indicates the influence of different environmental cues. We found that the Crp/CsrA/RovA regulatory cascades influence the pattern of bacterial gene expression during persistence. Furthermore, arcA, fnr, frdA, and wrbA play critical roles in persistence. Our findings suggest a model for the life cycle of this enteropathogen with reprogramming from a virulent to an adapted phenotype capable of persisting and spreading by fecal shedding. To establish infection and colonize within a host, infecting pathogens have to cope with a variety of destructive surroundings. The food-borne pathogen Y. pseudotuberculosis can cause persistent infection in mice. Upon infection, Y. pseudotuberculosis passes the anti-microbial gastrointestinal milieu and finally remains associated with lymphoid follicles in cecal tissue surrounded by polymorphonuclear leukocytes, indicating that the bacteria are exposed to multiple environmental cues. We performed complex RNA-seq of small cecal biopsies of infected mice to reveal Y. pseudotuberculosis gene expression in vivo. We found that Y. pseudotuberculosis underwent reprogramming from a virulent phenotype, expressing virulence genes during early infection, to an adapted phenotype capable of persisting in the harsh cecal environment. Persistence was characterized by a novel expression pattern with down-regulation of virulence genes and up-regulation of genes involved in anaerobiosis, chemotaxis, and protection against oxidative and acidic stress. Mutagenesis of selected genes revealed that the regulator rovA was critical for the establishment of infection, and that arcA, fnr, frdA, and wrbA play critical roles in maintaining infection for long periods of time. Our study shows the power of RNA deep sequencing, which can be used to reveal the in vivo expression patterns of small amounts of bacteria in complex intestinal environments.
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Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Colonization of cecum is important for development of persistent infection by Yersinia pseudotuberculosis. Infect Immun 2014; 82:3471-82. [PMID: 24891107 DOI: 10.1128/iai.01793-14] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Yersiniosis is a human disease caused by the bacterium Yersinia pseudotuberculosis or Yersinia enterocolitica. The infection is usually resolved but can lead to postinfectious sequelae, including reactive arthritis and erythema nodosum. The commonly used Yersinia mouse infection model mimics acute infection in humans to some extent but leads to systemic infection and eventual death. Here, we analyzed sublethal infection doses of Y. pseudotuberculosis in mice in real time using bioluminescent imaging and found that infections using these lower doses result in extended periods of asymptomatic infections in a fraction of mice. In a search for the site for bacterial persistence, we found that the cecum was the primary colonization site and was the site where the organism resided during a 115-day infection period. Persistent infection was accompanied by sustained fecal shedding of cultivable bacteria. Cecal patches were identified as the primary site for cecal colonization during persistence. Y. pseudotuberculosis bacteria were present in inflammatory lesions, in localized foci, or as single cells and also in neutrophil exudates in the cecal lumen. The chronically colonized cecum may serve as a reservoir for dissemination of infection to extraintestinal sites, and a chronic inflammatory state may trigger the onset of postinfectious sequelae. This novel mouse model for bacterial persistence in cecum has potential as an investigative tool to unveil a deeper understanding of bacterial adaptation and host immune defense mechanisms during persistent infection.
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Yiallouros P, Mavri A, Attilakos A, Moustaki M, Leontsini F, Karpathios T. Shewanella putrefaciens bacteraemia associated with terminal ileitis. Paediatr Int Child Health 2013; 33:193-5. [PMID: 23930735 DOI: 10.1179/2046905512y.0000000045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Shewanella putrefaciens has a wide geographical distribution, including sea- and fresh water, fish and soil, but it is an unusual pathogen in humans. A previously healthy boy without known immunodeficiency presented with fever, abdominal pain and diarrhoea, and a mass in the right lower quadrant. Terminal ileitis was confirmed by MRI and Shewanella putrefaciens was isolated from two separate blood cultures. This is the first report of terminal ileitis associated with Shewanella putrefaciens septicaemia.
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Roccarina D, Garcovich M, Ainora ME, Caracciolo G, Ponziani F, Gasbarrini A, Zocco MA. Diagnosis of bowel diseases: The role of imaging and ultrasonography. World J Gastroenterol 2013; 19:2144-2153. [PMID: 23599640 PMCID: PMC3627878 DOI: 10.3748/wjg.v19.i14.2144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/28/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
Examinations with a visualisation of the anatomy and pathology of the gastrointestinal (GI) tract are often necessary for the diagnosis of GI diseases. Traditional radiology played a crucial role for many years. Endoscopy, despite some limitations, remains the main technique in the differential diagnosis and treatment of GI diseases. In the last decades, the introduction of, and advances in, non-invasive cross-sectional imaging modalities, including ultrasound (US), computed tomography (CT), positron-emission tomography (PET), and magnetic resonance imaging, as well as improvements in the resolution of imaging data, the acquisition of 3D images, and the introduction of contrast-enhancement, have modified the approach to the examination of the GI tract. Moreover, additional co-registration techniques, such as PET-CT and PET-MRI, allow multimodal data acquisition with better sensitivity and specificity in the study of tissue pathology. US has had a growing role in the development and application of the techniques for diagnosis and management of GI diseases because it is inexpensive, non-invasive, and more comfortable for the patient, and it has sufficient diagnostic accuracy to provide the clinician with image data of high temporal and spatial resolution. Moreover, Doppler and contrast-enhanced ultrasound (CEUS) add important information about blood flow. This article provides a general review of the current literature regarding imaging modalities used for the evaluation of bowel diseases, highlighting the role of US and recent developments in CEUS.
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Singh A, Desser TS, Ferucci J. Imaging of Small Bowel. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Millet I, Alili C, Pages E, Curros Doyon F, Merigeaud S, Taourel P. Infection of the right iliac fossa. Diagn Interv Imaging 2012; 93:441-52. [PMID: 22658341 DOI: 10.1016/j.diii.2012.04.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Cogley JR, O'Connor SC, Houshyar R, Al Dulaimy K. Emergent pediatric US: what every radiologist should know. Radiographics 2012; 32:651-665. [PMID: 22582352 DOI: 10.1148/rg.323115111] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Appendicitis, intussusception, and hypertrophic pyloric stenosis (HPS) are three of the most common reasons for emergent abdominal imaging in pediatric patients. Although the use of computed tomography has risen dramatically over the past 2 decades, children are particularly at risk for the adverse effects of ionizing radiation, and even low-dose radiation is associated with a small but significant increase in lifetime risk of fatal cancer. In most emergency departments, the use of magnetic resonance (MR) imaging as a primary modality for the evaluation of a child with abdominal pain remains impractical due to its high cost, its limited availability, and the frequent need for sedation. Ultrasonography (US) does not involve ionizing radiation and, unlike MR imaging, is relatively inexpensive, is widely available, and does not require sedation. Another major advantage of US in abdominal imaging is that it allows dynamic assessment of bowel peristalsis and compressibility. Delayed diagnosis of any of the aforementioned disease processes can lead to serious morbidity and, in some cases, death. The ability to diagnose or exclude disease with US should be part of a core radiology skill set for any practice that includes a pediatric population.
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Affiliation(s)
- Jonathan R Cogley
- Department of Radiology, Baystate Medical Center and Children's Hospital, Western Campus of Tufts University School of Medicine, 759 Chestnut St, Springfield, MA 01199, USA.
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Tamboli CP, Good MR, Reynolds EM, Sharma P, Mitros FA. Anti-Yersinia antibodies are not associated with microscopic colitis in an American case-control study. Scand J Gastroenterol 2011; 46:1442-8. [PMID: 22017454 DOI: 10.3109/00365521.2011.627450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Microscopic colitis (MC), which consists of lymphocytic colitis and collagenous colitis, may be triggered by gastrointestinal infections. Studies have suggested a relationship between MC and Yersinia enterocolitica infection. We tested this hypothesis in a case-control study of American patients with MC. METHODS Serum was collected from 47 patients with MC and 44 age- and gender-matched healthy controls at a large referral center in the mid-western United States. Anti-IgA and IgG antibodies to Y. enterocolitica were measured using an enzyme-linked immunosorbent assay (ELISA). Fisher's exact test was used to assess statistical significance. RESULTS There were no differences between the two groups for seroprevalence of anti-Yersinia IgA (cases 2.1%, controls 2.3%, p = 1.00) or IgG antibodies (cases 4.3%, controls 6.8%, p = 0.67). There was no correlation between antibody titers and duration of MC diagnosis. CONCLUSION Our data do not support the role of exposure to Y. enterocolitica in an American group of patients with MC.
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Affiliation(s)
- Cyrus P Tamboli
- Department of Internal Medicine, University of Iowa, IA, USA.
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Heller MT, Hattoum A. Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis. Emerg Radiol 2011; 19:61-73. [PMID: 22072087 DOI: 10.1007/s10140-011-0997-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 10/24/2011] [Indexed: 12/11/2022]
Abstract
Evaluation of acute right lower quadrant pain remains a common and challenging clinical scenario for emergency medicine physicians due to frequent nonspecific signs, symptoms, and physical examination findings. Therefore, imaging has evolved to play a pivotal role in the emergency setting. While appendicitis is a common cause for acute pain, there are numerous other important differential considerations with which the radiologist must be aware. The purpose of this review is to list an anatomy-based, encompassing differential diagnosis in addition to acute appendicitis for right lower quadrant pain; demonstrate the key imaging findings of numerous differential considerations; and describe helpful imaging and clinical features useful in narrowing the differential diagnosis.
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Affiliation(s)
- Matthew T Heller
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Purysko AS, Remer EM, Filho HML, Bittencourt LK, Lima RV, Racy DJ. Beyond appendicitis: common and uncommon gastrointestinal causes of right lower quadrant abdominal pain at multidetector CT. Radiographics 2011; 31:927-947. [PMID: 21768232 DOI: 10.1148/rg.314105065] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Right lower quadrant abdominal pain is one of the most common causes of a patient visit to the emergency department. Although appendicitis is the most common condition requiring surgery in patients with abdominal pain, right lower quadrant pain can be indicative of a vast list of differential diagnoses and is thus a challenge for clinicians. Other causes of right lower quadrant pain beyond appendicitis include inflammatory and infectious conditions involving the ileocecal region; diverticulitis; malignancies; conditions affecting the epiploic appendages, omentum, and mesentery; and miscellaneous conditions. Multidetector computed tomography (CT) has emerged as the modality of choice for evaluation of patients with several acute traumatic and nontraumatic conditions causing right lower quadrant pain. Multidetector CT is an extremely useful noninvasive method for diagnosis and management of not only the most common causes such as appendicitis but also less common conditions.
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Abstract
Ileitis, or inflammation of the ileum, is often caused by Crohn's disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. The clinical presentation of ileitis may vary from an acute and self-limited form of right lower quadrant pain and/or diarrhea, as in the majority of cases of bacterial ileitis, but some conditions (ie, vasculitis or Mycobacterium tuberculosis) follow a chronic and debilitating course complicated by obstructive symptoms, hemorrhage, and/or extraintestinal manifestations. Ileitis associated with spondylarthropathy or nonsteroidal anti-inflammatory drugs is typically subclinical and often escapes detection unless further testing is warranted by symptoms. In a minority of patients with long-standing Crohn's ileitis, the recrudescence of symptoms may represent a neoplasm involving the ileum. Distinguishing between the various forms of ileitis remains a test of clinical acumen. The diagnosis of the specific etiology is suggested by a detailed history and physical examination, laboratory testing, and ileocolonoscopy and/or radiologic data.
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Affiliation(s)
- Steven Dilauro
- Scripps Clinic Torrey Pines, Division of Gastroenterology, La Jolla, CA 92037, USA
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Optimized protocol for diagnosis of acute ileitis. Clin Gastroenterol Hepatol 2009; 7:1183-8. [PMID: 19631291 DOI: 10.1016/j.cgh.2009.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 07/06/2009] [Accepted: 07/11/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Suspected acute ileitis (AI) is a poorly defined clinical condition with multiple causes; its diagnostic protocol has not been standardized properly. We performed a prospective evaluation of the incidence and causes of AI to create a standard protocol for diagnosis. METHODS The definition of AI included abdominal pain, diarrhea, fever, and at least 1 confirmatory imaging method (abdominal computed tomography scan or ultrasound) showing pathologic changes in the terminal ileum that indicated ileal inflammation. We studied all patients with a presumptive diagnosis of AI seen in the Emergency Room at the Ramón y Cajal Hospital in Madrid, from March 2005 to May 2007, according to a pre-established protocol. Sixty-six patients with primary AI were followed up for at least 6 months. RESULTS An infectious cause was found in 33.3% of cases; the most frequently detected microorganism was Yersinia spp. A gynecologic condition was identified in 9.1% of cases initially diagnosed as AI, representing 13.95% of the cases among female patients. Crohn's disease was identified in 12.1% of patients. The diagnostic protocol led to negative results in 33.4% of the patients; 6.1% of patients did not complete the study. The initial diagnosis did not change among any of the patients during the follow-up period. CONCLUSIONS This protocol led to a definitive diagnosis of AI in more than 60% of potential cases. The most common cause was acute infection. About 10% of cases were of gynecologic origin and about 12% of patients presented with Crohn's disease.
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Holtz LR, Neill MA, Tarr PI. Acute bloody diarrhea: a medical emergency for patients of all ages. Gastroenterology 2009; 136:1887-98. [PMID: 19457417 DOI: 10.1053/j.gastro.2009.02.059] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 02/06/2009] [Accepted: 02/17/2009] [Indexed: 01/05/2023]
Abstract
Acute bloody diarrhea should be considered a medical emergency. Its causes are frequently serious or actionable or both and are usually identified. However, acute bloody diarrhea as a stand-alone clinical presentation has received little scholarly attention in the past several decades. Although the range of possible causes of acute bloody diarrhea is broad, infectious considerations are paramount and should always be prioritized in the evaluation of such patients. History, examination, and laboratory testing should be focused on minimizing time to diagnosis (and, by extension, to implementing appropriate therapy). Strategically chosen tests and imaging, avoidance of extraneous diagnostic pursuits, and provision of supportive care while awaiting diagnostic clarity are central to the adroit management of patients with acute bloody diarrhea. Diagnostic considerations differ somewhat between adults and children but have many elements in common, including the need for vigilance in detecting Escherichia coli O157:H7 infection. In this review, we discuss diagnostic approaches (emphasizing the importance of rapid, accurate, and thorough microbiologic investigation) and measures that can be taken to support patients while awaiting information that determines the cause of their disease. These topics are discussed in the context of the medical care that is available to children and adults with bloody diarrhea in most institutions in developed nations.
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Affiliation(s)
- Lori R Holtz
- Department of Pediatrics, Division of Gastroenterology and Nutrition, Washington University School of Medicine, St Louis, Missouri 63110, USA
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Transabdominal sonography in assessment of the bowel in adults. AJR Am J Roentgenol 2009; 192:197-212. [PMID: 19098201 DOI: 10.2214/ajr.07.3555] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We describe the key sonographic features and technical aspects of assessment of bowel disorders in adults. CONCLUSION Initial imaging with transabdominal sonography in the radiologic evaluation of bowel disease in adults often is reserved for patients with equivocal historical, physical, and laboratory findings related to the gastrointestinal tract. Because of technologic advances and accumulated experience in interpretation of the images, sonography yields substantial information about gastrointestinal disorders.
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Hollerweger A. Colonic diseases: the value of US examination. Eur J Radiol 2007; 64:239-49. [PMID: 17889476 DOI: 10.1016/j.ejrad.2007.06.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 06/28/2007] [Accepted: 06/28/2007] [Indexed: 02/07/2023]
Abstract
The colon is affected by a number of diseases, mainly inflammatory, ischemic, and neoplastic conditions. Depending upon clinical indications endoscopy, US, CT, or other radiological methods are used for evaluation. The fact that US is frequently used as the initial imaging method in patients with non-specific clinical symptoms allows for greater influence in further diagnostic evaluation and with treatment, provided the investigator is familiar with the features of different intestinal diseases. This article will describe the anatomical characteristics of the colon, the US technique for examination of the colon, and the typical US features of the more common diagnoses of the colon.
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Affiliation(s)
- Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Hospital Barmherzige Brüder, Kajetanerplatz 1, A-5020 Salzburg, Austria.
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van Breda Vriesman AC, Puylaert JBCM. Mimics of Appendicitis: Alternative Nonsurgical Diagnoses with Sonography and CT. AJR Am J Roentgenol 2006; 186:1103-12. [PMID: 16554587 DOI: 10.2214/ajr.05.0085] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to illustrate the imaging features of alternative nonsurgical disorders in patients presenting with clinical signs of appendicitis. CONCLUSION This article illustrates the sonographic and CT features of various appendicitis-mimicking conditions that are self-limiting or that can be treated conservatively. A correct imaging diagnosis of these disorders may prevent a nontherapeutic appendectomy and unnecessary hospitalization.
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Affiliation(s)
- Adriaan C van Breda Vriesman
- Department of Radiology, Rijnland Hospital, Simon Smitweg 1, P.O. Box 4220, NL-2350 CC, Leiderdorp, The Netherlands.
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Kasper DL, Sahani D, Misdraji J. Case records of the Massachusetts General Hospital. Case 25-2005. A 40-year-old man with prolonged fever and weight loss. N Engl J Med 2005; 353:713-22. [PMID: 16107625 DOI: 10.1056/nejmcpc059020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dennis L Kasper
- Department of Medicine, Brigham and Women's Hospital, Boston, USA
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Görg C, Wollenberg B, Beyer J, Stolte MS, Neubauer A. High-resolution ultrasonography in gastrointestinal graft-versus-host disease. Ann Hematol 2004; 84:33-9. [PMID: 15526100 DOI: 10.1007/s00277-004-0893-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 05/13/2004] [Indexed: 11/30/2022]
Abstract
Gastrointestinal graft-versus-host disease (GVHD) is one of the main causes of therapy-related death after allogeneic hemopoietic stem cell transplantation. Early diagnosis and immediate treatment are probably essential for improving clinical outcome. High-resolution sonography allows the evaluation of single bowel wall layers throughout the small and large bowel. We report the sonographic findings of seven consecutive patients with histologically confirmed GVHD grade II-IV of the gastrointestinal tract. The patients were examined sonographically within the 1st week after onset of clinical symptoms. Dilatation of the colon and striking bowel wall thickening were early and common features in these patients. Sonography may become a useful tool for diagnosis of patients with gastrointestinal GVHD. Its role for preclinical diagnosis, grading of severity of disease, and guiding therapy of patients with gastrointestinal GVHD warrants evaluation in prospective studies.
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Affiliation(s)
- C Görg
- Department of Hematology and Oncology, Philipps-University Marburg, Marburg, Germany.
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Baud C, Saguintaah M, Veyrac C, Couture A, Ferran JL, Barnéon G, Veyrac M. Sonographic diagnosis of colitis in children. Eur Radiol 2004; 14:2105-19. [PMID: 15232710 DOI: 10.1007/s00330-004-2358-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2003] [Revised: 03/19/2004] [Accepted: 04/13/2004] [Indexed: 12/30/2022]
Abstract
To assist the radiologist in differentiating the colitis in children, this review proposes a systematic US approach to the disease, presents the US aspect of the normal colon and describes three distinctive US patterns reflecting the intramural extension of the histopathological changes. Each pattern corresponds to one or several diseases producing alterations in the same layer(s). Stratified thickening suggests an inflammatory mucosal process resulting from infection (as in advanced appendicitis or in infectious colitis) or to inflammation (as in IBD). Nonstratified thickening with loss of the haustral folds reflects a marked submucosal infiltrate. Color Doppler is required to distinguish between an inflammatory disease (as advanced CD or neutropenic colitis) and an ischemic colitis (HUS in children). Nonstratified thickening with preservation of the length of the haustral folds is the sign of an intraluminal deposit due to PMC. Correlating the sonographic pattern and the anatomic distribution of the disease with the clinical and laboratory findings often permits to propose a specific diagnosis.
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Affiliation(s)
- C Baud
- Service de Radiologie Pédiatrique, Hôpital Arnaud de Villeneuve, 371 av. du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
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Sturm EJC, Cobben LPJ, Meijssen MAC, van der Werf SDJ, Puylaert JBCM. Detection of ileocecal Crohn's disease using ultrasound as the primary imaging modality. Eur Radiol 2004; 14:778-82. [PMID: 14760505 DOI: 10.1007/s00330-003-2204-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Revised: 07/31/2003] [Accepted: 12/01/2003] [Indexed: 12/15/2022]
Abstract
At our hospital ultrasound (US) is used as an initial screening procedure in all patients with abdominal symptoms. The purpose of this study was to assess the effect of this policy on the detection of ileocecal Crohn's disease. We retrospectively studied all patients with a new diagnosis of ileocecal Crohn's disease from our institute over the period 1990-2001. The final diagnosis was based on clinical follow-up and pathological, surgical, US, and other radiological findings. We noted who referred the patient to the radiology department, what the initial clinical presumption was, and what the first imaging study was. US diagnoses were determined from the initial US report and US findings were registered from the images. There were a total of 47 patients (20 men, 27 women) with a mean age of 30 years and a median age of 27 years (range 14-75 years). In all patients the initial imaging study was an abdominal US. Using US, a confident diagnosis of ileocecal Crohn's disease was made in 35 of the 47 patients, Crohn's disease was suggested among the differential diagnosis in 10, and an incorrect diagnosis was made in 2 patients. In 28 of 47 patients, the referring physician did not consider Crohn's disease when requesting the initial US examination. In eight patients with appendicitis-like symptoms, the US findings strongly influenced the decision to refrain from operation at that point in time. US, when used as a low-threshold diagnostic procedure, is a reliable and noninvasive means for making an early diagnosis of ileocecal Crohn's disease in patients who present with atypical symptoms. It may prevent both unnecessary therapeutic delay as well as unnecessary surgery.
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Affiliation(s)
- E J C Sturm
- Department of Radiology, Deventer Hospital, Fesevurstraat 7, 7400 GC Deventer, The Netherlands
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Abstract
Although multislice, helical CT is increasingly replacing ultrasonography for the evaluation of patients with acute abdominal pain, ultrasound does have certain specific advantages over CT. This article discusses the advantages of ultrasound in imaging of the acute abdomen, exploring such areas as appendicitis, ileocecal Crohn's disease, infectious ileocolitis and infectious ileocecitis, mesenteric lymphadenitis, cecal carcinoma, sigmoid diverticulitis, right-sided colonic diverticulitis, and perforated peptic ulcer.
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Tarantino L, Giorgio A, de Stefano G, Scala V, Esposito F, Liorre G, Farella N, Ferraioli G. Acute appendicitis mimicking infectious enteritis: diagnostic value of sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:945-950. [PMID: 14510266 DOI: 10.7863/jum.2003.22.9.945] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. METHODS One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm3 (range, 10,300-18,000/mm3). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. RESULTS Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. CONCLUSIONS Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever.
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Affiliation(s)
- Luciano Tarantino
- Interventional Ultrasound Service, D. Cotugno Hospital for Infectious Diseases, Naples, Italy.
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