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Kurokawa M, Kurokawa R, Hagiwara A, Gonoi W, Harayama S, Koizumi K, Yoshino K, Hishima T, Baba A, Ota Y, Abe O, Takaki Y. CT imaging findings of anti-PD-1 inhibitor-related enterocolitis. Abdom Radiol (NY) 2021; 46:3033-3043. [PMID: 33638055 DOI: 10.1007/s00261-021-02986-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Immune checkpoint inhibitors promote the antitumor activity of T cells; however, there is a risk of side effects. The aim of this study was to characterize the computed tomography (CT) findings of one such side effect, anti-programmed cell death-1 antibody-related enterocolitis (αPD-1-EC). METHODS This single-institution retrospective study included 21 patients with αPD-1-EC who underwent CT between January 2015 and April 2020. Two board-certified radiologists independently evaluated the CT findings, including the pattern of intestinal wall enhancement, maximum bowel wall thickness, maximum appendiceal diameter, and involvement of enterocolitis in each intestinal segment. Symptoms and their severity were also investigated. RESULTS Pancolitis and skip lesions involving both the rectosigmoid colon and the cecum were found in 9 patients each (42.9%). The rectum was the most frequently involved lesion (18/21, 85.7%), and appendiceal involvement was found in 11 patients (52.4%). The most frequent wall enhancement pattern was the gray pattern (i.e., mild homogeneous enhancement of the thickened bowel wall). The mean maximum diameter of the involved appendix was 9.6 ± 4.5 mm (range 4.5-18 mm). Frequent symptoms included diarrhea (21/21), fever (8/21), and abdominal pain (7/21). Other concomitant immune-related adverse events were found in 6 patients. CONCLUSIONS Pancolitis, skip lesions, and appendiceal involvement were frequent in patients with αPD-1-EC. When combining these characteristic findings with other clinical findings, such as low-grade diarrhea, other concomitant immune-related adverse events, and anti-PD-1 therapy administration, CT may be a useful diagnostic tool for αPD-1-EC.
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Affiliation(s)
- Mariko Kurokawa
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shinjiro Harayama
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Koichi Koizumi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Koji Yoshino
- Department of Dermato Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Akira Baba
- Department of Radiology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasunobu Takaki
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Shapiro JM, Balza R, Virk Hundal NK, Hesterberg PE, Zukerberg LR. Case 23-2017. A 9-Day-Old Girl with Vomiting, Acidosis, and Azotemia. N Engl J Med 2017; 377:372-383. [PMID: 28745994 DOI: 10.1056/nejmcpc1703512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason M Shapiro
- From the Department of Pediatrics, Rhode Island Hospital and Hasbro Children's Hospital, and the Department of Pediatrics, Warren Alpert Medical School of Brown University - both in Providence (J.M.S.); and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H., P.E.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Rene Balza
- From the Department of Pediatrics, Rhode Island Hospital and Hasbro Children's Hospital, and the Department of Pediatrics, Warren Alpert Medical School of Brown University - both in Providence (J.M.S.); and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H., P.E.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Navneet K Virk Hundal
- From the Department of Pediatrics, Rhode Island Hospital and Hasbro Children's Hospital, and the Department of Pediatrics, Warren Alpert Medical School of Brown University - both in Providence (J.M.S.); and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H., P.E.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Paul E Hesterberg
- From the Department of Pediatrics, Rhode Island Hospital and Hasbro Children's Hospital, and the Department of Pediatrics, Warren Alpert Medical School of Brown University - both in Providence (J.M.S.); and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H., P.E.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Lawrence R Zukerberg
- From the Department of Pediatrics, Rhode Island Hospital and Hasbro Children's Hospital, and the Department of Pediatrics, Warren Alpert Medical School of Brown University - both in Providence (J.M.S.); and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H., P.E.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiology (R.B.), Pediatrics (N.K.V.H.), Medicine (P.E.H.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
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Müller K, Schmidt J, Tuma J. [Ultrasonography 67. Abdominal pain]. Praxis (Bern 1994) 2015; 104:1414-1416. [PMID: 26649964 DOI: 10.1024/1661-8157/a002217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Jan Schmidt
- 2 Chirurgisches Zentrum Zürich, Standort Klinik Im Park
| | - Jan Tuma
- 1 Institut für Sonographie, Uster
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4
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Kobayashi A, Adachi Y, Iwata Y, Sakai Y, Shigemitu K, Todoroki M, Ide M. Abdominal ultrasonographic findings in typhoid fever: a comparison between typhoid patients and those with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis. Southeast Asian J Trop Med Public Health 2012; 43:423-430. [PMID: 23082592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Typhoid fever is a major health problem in many developing countries and its clinical features are similar to other types of bacterial enterocolitis. Definitive diagnosis by blood culture requires several days and is often unfeasible to perform in developing countries. More efficient and rapid diagnostic methods for typhoid are needed. We compared the pathological changes in the bowel and adjacent tissues of patients having typhoid fever with those having bacterial enterocolitis using ultrasonography. A characteristic of patients with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis was mural thickening of the terminal ileum; only mild mural swelling or no swelling was observed in patients with typhoid fever. Mesenteric lymph nodes in patients with typhoid fever were significantly more enlarged compared to patients with other types of bacterial enterocolitis. Our findings suggest typhoid fever is not fundamentally an enteric disease but rather resembles mesenteric lymphadenopathy and ultrasound is a promising modality for diagnosing typhoid fever in developing countries.
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Shah BK, KC R. Fatal neutropenic enterocolitis due to clostridium septicum. W INDIAN MED J 2011; 60:594-595. [PMID: 22519241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe a case of Clostridium septicum enterocolitis in a patient with pre-B acute lymphoblastic leukaemia undergoing autologous stem cell transplant. In the setting of neutropenia, Clostridium septicum should be suspected in patients who develop signs and symptoms of acute abdomen.
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Affiliation(s)
- B K Shah
- St Joseph Regional Cancer Center, 1250 Idaho Street, Lewiston, Idaho, USA.
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Kobayashi K, Yokote T, Akioka T, Hiraoka N, Oka S, Hara S, Miyoshi T, Hirata Y, Takubo T, Tsuji M, Hanafusa T. Unique intestinal CT imaging with bleeding from a duodenal diverticulum following myelodysplastic syndrome. Intern Med 2008; 47:1039-41. [PMID: 18520117 DOI: 10.2169/internalmedicine.47.0856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Duodenal diverticula generally occur in 2.5% of upper gastrointestinal examinations and are usually asymptomatic, but can cause hemorrhage on rare occasions. The frequency of gastrointestinal hemorrhage in patients with MDS or hematologic neoplasm caused by duodenal diverticulum is not known. Therefore, the correct diagnosis of intestinal hemorrhage is important, as severe enterocolitis may cause a patient with MDS to bleed from the diverticulum.
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Affiliation(s)
- Richard Kuo
- Department of Radiology, Mackay Memorial Hospital, 92, Section 2, Chungshan North Road, Taipei, Taiwan.
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Affiliation(s)
- Hon-Yi Lin
- Tri-Service General Hospital, Taipei 114, Taiwan.
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10
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Shimada N, Honda Y, Sugimoto M. [Image diagnosis of abdominal infectious diseases (infectious enterocolitis and Fitz-Hugh-Curtis Syndrome)]. Nihon Rinsho 2007; 65 Suppl 2 Pt. 1:247-50. [PMID: 17455625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Nagato Shimada
- Department of General Medicine and Emergency Care, Toho University School of Medicine
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11
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Affiliation(s)
- C Bird
- John Radcliffe Hospital, Oxford OX3 9DU, UK
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12
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Hoeffel C, Crema MD, Belkacem A, Azizi L, Lewin M, Arrivé L, Tubiana JM. Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics 2006; 26:1373-90. [PMID: 16973770 DOI: 10.1148/rg.265045191] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The ileocecal area is a relatively short segment of the gastrointestinal tract but may be affected by pathologic conditions that are either common throughout the gastrointestinal system or exclusive to this area. These conditions include benign and malignant tumors, inflammatory processes (appendicitis, diverticulitis, epiploic appendagitis, Crohn disease), infectious diseases, and miscellaneous conditions (cecal ischemia, typhlitis, cecal volvulus, duplication cyst). The various components of the ileocecal area (cecum, appendix, ileocecal valve, terminal ileum) are close to one another, so that these conditions may involve more than one anatomic structure, thereby creating a diagnostic dilemma. The evaluation of various parameters (eg, stratified enhancement pattern of the thickened bowel wall, degree of thickening, extent and location of bowel wall involvement, degree of fat stranding relative to the degree of wall thickening) and associated findings (lymph nodes, mesenteric stranding, abscess and sinus tracts, fatty proliferation, solid organ abnormalities) will help narrow the differential diagnosis. Multi-detector row computed tomography (CT) is considered the best imaging examination for the evaluation of the ileocecal area. Consequently, the radiologist should be familiar with the multi-detector row CT features of the spectrum of diseases affecting this area to help ensure correct diagnosis and appropriate treatment.
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Affiliation(s)
- Christine Hoeffel
- Department of Radiology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France.
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Abstract
Two immunocompromised adult patients (male, 43 years of age; female, 50 years of age) are described who developed unusual and similarly unique complications. After chemotherapy, both presented with abdominal pain and severe bloody diarrhea. Initial blood cultures were negative, and abdominal CT showed pneumatosis and thickening of colonic wall. Colonoscopy showed severe right-sided colitis. Relentless bloody diarrhea necessitated emergency right hemicolectomy in both cases. Pathologic examination of the specimens showed extensive and severe hematogenous Candida enterocolitis. Both patients died of acute cerebral hemorrhage within 3 days of hemicolectomy. Autopsy, performed on 1 of the 2 cases, showed diffuse severe cerebritis and cerebral hemorrhage secondary to hematogenous invasive candidiasis. This sequence of events is not documented in the English literature on candidal enterocolitis, which is reviewed.
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Affiliation(s)
- David Cimbaluk
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA.
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14
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Abstract
Cow's milk allergic enterocolitis is a common paediatric gastrointestinal disease. However, radiological findings from contrast studies have rarely been reported. We report two Japanese neonate patients with cow's milk allergic enterocolitis with vomiting, bloody stool and unique findings on upper gastrointestinal contrast study. Upper gastrointestinal contrast study showed folds of the small intestine to be thickened, such as in spasm, or ribbon-like cords in both cases. There was also poor passage from the duodenum to the jejunum in one case. In addition, there were spastic findings on lower gastrointestinal contrast study in part of the large colon in one case. Clinicians, including paediatric surgeons, treating neonates with bloody stool and/or vomiting should thus be aware that unique findings on upper and lower gastrointestinal contrast studies may be useful in suspecting cases with cow's milk allergic enterocolitis.
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Affiliation(s)
- Kouji Masumoto
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Kyushu University, Fukuoka, Japan.
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15
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Haddad MC, Khouzami RA, Saad HA, Azzi MC. Imaging findings of radiation enteritis. J Med Liban 2004; 52:55-7. [PMID: 15881704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In this report the authors describe the imaging features of subacute and chronic radiation enteritis in two patients. Although surgery remains the definitive treatment of complicated chronic radiation enteritis, the potential role of interventional techniques that can be used for management of poor surgical candidates is discussed.
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Affiliation(s)
- Maurice C Haddad
- American University of Beirut Medical Center, Department of Diagnostic Radiology, PO Box 11-0236, Beirut, Lebanon.
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Ozçay F, Kayiran SM, Ozbek N. Successful medical management of neutropenic enterocolitis (typhlitis) in a child with acute lymphoblastic leukemia. Turk J Pediatr 2003; 45:248-50. [PMID: 14696805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
We report a case of acute lymphoblastic leukemia that was complicated by neutropenic enterocolitis (typhlitis) during the initial period of remission-induction chemotherapy. The patient's clinical symptoms resolved after aggressive treatment with intravenous fluids and electrolytes, nasogastric decompression, bowel rest, total parenteral nutrition, broad-spectrum antibiotics, and granulocyte colony-stimulating factor. Netropenic enterocolitis should always be considered in neutropenic leukemic children with the triad of fever, vomiting, and abdominal pain. Gastrointestinal hemorrhage may also accompany the symptoms described above. Plain roentgenogram, ultrasonography and computed tomography of the abdomen are helpful for making the diagnosis of this clinical condition. Early recognition and proper medical management of neutropenic enterocolitis may prevent the need for surgical intervention, and/or be life-saving.
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Affiliation(s)
- Figen Ozçay
- Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey
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O'Connor K, Dijkstra B, Kelly L, McDermott EW, Hill ADK, O'Higgins N. Successful conservative management of neutropenic enterocolitis: a report of two cases and review of the literature. ANZ J Surg 2003; 73:463-5. [PMID: 12801351 DOI: 10.1046/j.1445-2197.2003.02660.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kevin O'Connor
- Department of Surgery, St Vincent's University Hospital, and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
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Bacry A. [I--emergencies 6/enterocolitis]. Soins Pediatr Pueric 2003:43-4. [PMID: 12751190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Kresnik E, Gallowitsch HJ, Mikosch P, Würtz F, Alberer D, Hebenstreit A, Kogler D, Gasser J, Igerc I, Kumnig G, Gomez I, Lind P. 18F-FDG positron emission tomography in the early diagnosis of enterocolitis: preliminary results. Eur J Nucl Med Mol Imaging 2002; 29:1389-92. [PMID: 12271424 DOI: 10.1007/s00259-002-0901-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Collagenous and eosinophilic colitis are rare diseases characterised by chronic watery diarrhoea. Radiographic evaluation of the gastrointestinal tract and colonoscopy are usually non-diagnostic since as many as one-third of patients will have minor abnormalities. To date a few investigators have reported increased fluorine-18 fluorodeoxyglucose ((18)F-FDG) uptake on positron emission tomography (PET) in patients with acute enterocolitis, but there have been no reports on the use of (18)F-FDG PET for the diagnosis of collagenous or eosinophilic colitis in an early clinical stage. The aim of this preliminary study was to evaluate the usefulness of (18)F-FDG PET in the early diagnosis of patients with colitis. We investigated five women (mean age 61.2+/-12.1 years) who had been diagnosed as having colitis in an early clinical stage. In all but one of the patients, the diagnosis of colitis was based on biopsy. Magnetic resonance colonography, ultrasonography and colonoscopy were performed in all but one of the patients. Two women were identified as having collagenous colitis in an early clinical stage. Another two patients had eosinophilic colitis. The morphological imaging methods, magnetic resonance colonography and ultrasonography, yielded no suspicious findings, and the results of colonoscopy similarly showed no abnormalities. One patient had colitis due to bacterial infection. In all patients (18)F-FDG PET showed a pathological increase in tracer uptake in the large bowel, suggestive of colitis. In four of the five patients, colitis was confirmed by histology, and in one, by bacterial analysis. (18)F-FDG PET was able to detect colitis in an early clinical stage, when morphological imaging methods and colonoscopy were non-diagnostic. The early performance of (18)F-FDG PET imaging in patients with possible colitis is encouraging.
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Affiliation(s)
- E Kresnik
- Nuclear Medicine and Special Endocrinology, PET Centre, General Hospital, St. Veiterstrasse 47, 9020 Klagenfurt, Austria.
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Wiesner W, Kocher T, Heim M, Bongartz G. CT findings in eosinophilic enterocolitis with predominantly serosal and muscular bowel wall infiltration. JBR-BTR 2002; 85:4-6. [PMID: 11936478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A 44-year-old female presented with tenderness of her abdomen, vomiting, intestinal obstruction, hypoalbuminemia and blood eosinophilia. Gastroscopy was normal and colonoscopic biopsies showed only non-specific inflammation of the colonic mucosa and submucosa. CT revealed large amounts of ascites and bilateral pleural effusions but eosinophil counts in the ascites were normal. At CT the jejunum was dilated and showed marked prominence of the valvulae whereas the ileum and the colon presented with a diffuse and hypoattenuating bowel wall thickening. The bowel wall thickening was most pronounced in the colon which especially showed also an impressive thickening and hyperenhancement mainly of its outer bowel wall layers. Parasitic infection could be excluded as well as a specific allergic response. In context with the known blood eosinophilia the diagnosis of an eosinophilic enterocolitis was suspected already by CT but finally only surgical full thickness biopsies could confirm the rare diagnosis of an eosinophilic enterocolitis with predominantly serosal and muscular bowel wall infiltration.
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Affiliation(s)
- W Wiesner
- Institute of Diagnostic Radiology, University Hospital Basel, Switzerland
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Kettaneh A, Lenglet T, Poulet B, Michot J, Barrat C, Seror O, Prevot S, Thomas M, Fain O. [Pseudotumoral enterocolic phlebitis of the cecum and rutoside. A case report]. Rev Med Interne 2002; 23:465-8. [PMID: 12064219 DOI: 10.1016/s0248-8663(02)00595-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Enterocolic phlebitis is an entity characterized by ischemic injury of the gastrointestinal tract caused by thrombophlebitis of the mesenteric veins without arterial involvement or systemic disease. EXEGESIS We report a case of enterocolic phlebitis in a 57-year-old female treated by rutoside, revealed by intestinal obstruction related to a pseudotumoral lesion of the caecum. CONCLUSION This case adds to the four cases of enterocolic phlebitis under rutoside already reported in the literature, suggesting a possible involvement of this drug in this rare disease.
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Affiliation(s)
- A Kettaneh
- Services de médecine interne, hôpital Jean-Verdier, 93143 Bondy, France.
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Gorschlüter M, Marklein G, Höfling K, Clarenbach R, Baumgartner S, Hahn C, Ziske C, Mey U, Heller R, Eis-Hübinger AM, Sauerbruch T, Schmidt-Wolf IGH, Glasmacher A. Abdominal infections in patients with acute leukaemia: a prospective study applying ultrasonography and microbiology. Br J Haematol 2002; 117:351-8. [PMID: 11972517 DOI: 10.1046/j.1365-2141.2002.03434.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A prospective study of 62 chemotherapy-induced neutropenic episodes in patients with acute leukaemia was conducted to determine the incidence and causes of abdominal infections, and to assess the diagnostic value of the combined use of ultrasonography (US) and microbiology. Each patient underwent US of liver, gallbladder and complete bowel before chemotherapy, on days 2-4 after the end of chemotherapy and in cases of fever, diarrhoea or abdominal pain. US was combined with a standardized clinical examination and a broad spectrum of microbiological investigations. From January to August 2001, 243 US examinations were performed. The overall incidence of abdominal infectious diseases was 17.7% (11 out of 62, 95% confidence interval (CI): 9-29%). Four patients (6.5%) developed neutropenic enterocolitis; two of them died, two survived. Bowel wall thickening (BWT) > 4 mm in these four patients ranged from 5.8 to 23.6 mm and was detected only in one patient with mucositis. In three other patients (4.8%) Clostridium difficile, and in one patient (1.6%) Campylobacter jejuni, caused enterocolitis without BWT. Cholecystitis was diagnosed in three patients (4.8%) and hepatic candidiasis was strongly suspected in one patient. Abdominal infections caused by gastroenteritis viruses, cytomegalovirus (CMV) or Cryptosporidium were not observed. We conclude that in neutropenic patients with acute leukaemia receiving chemotherapy: (i) BWT is not a feature of chemotherapy-induced mucositis and should therefore be considered as sign of infectious enterocolitis; (ii) viruses, classic bacterial enteric pathogens (Salmonella, Shigella, Yersinia, Campylobacter, Aeromonas, Vibrio subsp., enterohaemorrhagic Escherichia coli) and Cryptosporidium have a very low incidence; and (iii) abdominal infections may be underestimated when US is not used in every patient with abdominal pain.
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Affiliation(s)
- Marcus Gorschlüter
- Department of Internal Medicine I, Institute of Medical Microbiology and Immunology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
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Cartoni C, Dragoni F, Micozzi A, Pescarmona E, Mecarocci S, Chirletti P, Petti MC, Meloni G, Mandelli F. Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol 2001; 19:756-61. [PMID: 11157028 DOI: 10.1200/jco.2001.19.3.756] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Neutropenic enterocolitis (NE) is a severe complication of intensive chemotherapy and is barely identifiable by clinical signs alone. Ultrasonography (US) supports the diagnosis of NE by showing pathologic thickening of the bowel wall. The aim of this study was to evaluate the prognostic value of the degree of mural thickening evaluated by US in patients with clinically suspected NE. PATIENTS AND METHODS Neutropenic patients with fever, diarrhea, and abdominal pain after intensive chemotherapy for hematologic malignancies were studied with abdominal US. We evaluated the degree of bowel wall thickening detected by US and its correlation with the duration of the clinical syndrome as well as NE-related mortality. RESULTS Eighty-eight (6%) of 1,450 consecutive patients treated for leukemia had clinical signs of NE. In 44 (50%) of 88 patients, US revealed pathologic wall thickening (mean +/- SD, 10.2 +/- 2.9 mm; range, 6 to 18). The mean duration of symptoms was significantly longer in this group (7.9 days) than among patients without mural thickening (3.8 days, P <.0001), and the NE-related mortality rate was higher (29.5% v 0%, P <.001). Patients with bowel wall thickness of more than 10 mm had a significantly higher mortality rate (60%) than did those with bowel wall thickness < or = 10 mm (4.2%, P <.001). CONCLUSION Symptomatic patients with sonographically detected bowel wall thickening have a poor prognosis compared with patients without this finding. In addition, mural thickness of more than 10 mm is associated with poorer outcome among patients with NE.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Blast Crisis/complications
- Blast Crisis/drug therapy
- Child
- Enterocolitis/chemically induced
- Enterocolitis/diagnostic imaging
- Enterocolitis/mortality
- Enterocolitis/pathology
- Humans
- Intestines/diagnostic imaging
- Intestines/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/drug therapy
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/diagnostic imaging
- Neutropenia/mortality
- Neutropenia/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Prognosis
- Ultrasonography
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Affiliation(s)
- C Cartoni
- Department of Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, University La Sapienza, Rome, Italy.
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24
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Brown G, Bui A, Vrazas J. Florid computed tomographic appearance of acute Campylobacter enterocolitis. Australas Radiol 2000; 44:204-5. [PMID: 10849986 DOI: 10.1046/j.1440-1673.2000.00784.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
A 28-year-old male presented with severe abdominal pain and bloody diarrhoea. Computed tomographic scan showed marked swelling of the distal ileum and entire colorectum. The patient recovered and Campylobacter jejuni was subsequently grown from his faeces.
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Affiliation(s)
- G Brown
- Department of Gastroenterology, Western Hospital, Footscray, Victoria, Australia.
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25
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Abstract
BACKGROUND Salmonella enterocolitis (SE) is one of the important causes of acute infectious diarrhoea. Imaging studies are rarely performed on these patients. Consequently, ultrasound (US) features of SE are controversial. OBJECTIVE To identify the clinical significance of US in the evaluation of SE. MATERIAL AND METHODS Abdominal US was performed in 15 patients with SE and 9 patients with Rotavirus enterocolitis (RE). RESULTS Ascites was present in 60 % and mural thickening of the colon in 40 % of patients with SE on abdominal US, whereas we could not identify these features in patients with RE. In patients with SE, colonic wall thickening; and ascites, the levels of C-reactive protein (CRP) were significantly higher as compared to patients with SE and no colonic wall thickening or ascites. Also, the stool occult blood test was positive more often in patients with colonic wall thickening and ascites on US than in patients without these findings. The colonic wall thickness significantly correlated with CRP and stool occult blood level. CONCLUSIONS US is able to identify pathological changes in bowel and intra-abdominal spaces. The US findings of ascites and colonic wall thickening may be useful for determining the severity of SE.
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Affiliation(s)
- D Ueda
- Department of Paediatrics, Sapporo Higashi Tokushukai Hospital, 3-21, E13, N33, Higashi-ku, Sapporo, 065, Japan
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26
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Picardi M, Selleri C, Camera A, Catalano L, Rotoli B. Early detection by ultrasound scan of severe post-chemotherapy gut complications in patients with acute leukemia. Haematologica 1999; 84:222-5. [PMID: 10189386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Acute leukemia patients may develop life-threatening gut complications after intensive chemotherapy. We evaluated the role of abdominal and pelvic ultrasound (US) examination in early detection of these complications. DESIGN AND METHODS A cohort of twenty adult acute leukemia patients undergoing intensive chemotherapy for remission induction entered the study. All chemotherapy regimens included cytarabine by continuous i.v. infusion for several days. RESULTS Three patients had severe gut complications: 2 cases of enterocolitis and 1 case of gall bladder overdistension in the absence of calculi. In all cases the abnormality was documented by US examination: US scan showed thickening of the intestinal wall (two cases), and gall bladder overdistension with biliary sludge (one case). Immediate medical care included bowel rest, a broad-spectrum antibiotic, antimycotic treatment, and granulocyte colony-stimulating factor. All patients recovered from the complication. INTERPRETATION AND CONCLUSIONS We believe that the favorable outcome obtained in our small series can be attributed to early diagnosis followed by appropriate treatment. Early recognition by US and immediate medical management can lead to complete recovery of severe intestinal complications in patients with acute leukemia undergoing intensive chemotherapy.
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MESH Headings
- Acute Disease
- Adult
- Anti-Infective Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Dilatation, Pathologic/chemically induced
- Dilatation, Pathologic/diagnostic imaging
- Enterocolitis/chemically induced
- Enterocolitis/diagnostic imaging
- Enterocolitis/drug therapy
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Gallbladder Diseases/chemically induced
- Gallbladder Diseases/diagnostic imaging
- Gallbladder Diseases/drug therapy
- Gastrointestinal Diseases/chemically induced
- Gastrointestinal Diseases/diagnostic imaging
- Gastrointestinal Diseases/therapy
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Humans
- Idarubicin/administration & dosage
- Idarubicin/adverse effects
- Intubation, Gastrointestinal
- Leukemia/complications
- Leukemia/drug therapy
- Leukemia, Myelomonocytic, Acute/complications
- Leukemia, Myelomonocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/complications
- Leukemia, Promyelocytic, Acute/drug therapy
- Male
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/complications
- Neutropenia/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Treatment Outcome
- Ultrasonography
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Affiliation(s)
- M Picardi
- Division of Hematology, Federico II University Medical School, Naples, Italy
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27
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Abstract
Twenty-nine cases of neutropenic enterocolitis (NEC) were identified from 1992 to June 1996, and their clinical, microbiological, and radiologic characteristics were reviewed. Eighteen of 29 episodes were considered to be definite NEC since abdominal computed tomographic or ultrasonographic findings (n = 14) and/or pathological findings (n = 7) were consistent with the diagnosis, whereas 11 were classified as possible NEC since these findings were normal or nondiagnostic. Abdominal pain, diarrhea, and fever occurred in nearly all cases in both groups, whereas bloody stools were more frequent and the duration of diarrhea was longer in definite cases. Other clinical, laboratory, and microbiological findings were of variable frequencies, with no apparent differences between groups. All 29 patients received medical/supportive treatment, and only five deaths were related to NEC. We conclude that NEC has a broad spectrum of clinical presentation, but patients whose imaging studies are positive appear to have a more serious form of the disease. Medical management appears appropriate in most cases, as the associated mortality rate is < 20%.
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Affiliation(s)
- L Gomez
- Department of Medical Specialties, M.D. Anderson Cancer Center, Houston, Texas, USA
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28
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Gückel C. Typhoid fever. J Belge Radiol 1995; 78:230. [PMID: 7592298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C Gückel
- Institut für Diagnostische Radiologie, Kantonsspital Basel, Switzerland
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29
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Abstract
A 60-year-old woman with a remote history of colon carcinoma was studied with F-18 FDG PET imaging 5 days after admission for acute toxigenic enterocolitis. Marked and diffusely increased uptake was noticed throughout the ascending and transverse colon, which was noticed to be edematous and thickened on contrast CT examination. The study emphasizes the need to consider nonneoplastic entities, such as enterocolitis in the differential diagnosis of intensely hypermetabolic colonic lesions on F-18 FDG PET examinations.
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Affiliation(s)
- M A Meyer
- Department of Radiology University of Tennessee PET Imaging Center, Knoxville, USA
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30
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Almer S, Peters AM, Ekberg S, Franzén L, Granerus G, Ström M. Is computer-aided interpretation of 99Tcm-HMPAO leukocyte scans better than the naked eye? Nucl Med Commun 1995; 16:290-8. [PMID: 7624110 DOI: 10.1097/00006231-199504000-00161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to compare visual interpretation of inflammation detected by leukocyte scintigraphy with that of different computer-aided quantification methods, 34 patients (25 with ulcerative colitis and 9 with endoscopically verified non-inflamed colonic mucosa), were investigated using 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) leukocyte scintigraphy and colonoscopy with biopsies. Scintigrams were obtained 45 min and 4 h after the injection of labelled cells. Computer-generated grading of seven colon segments using four different methods was performed on each scintigram for each patient. The same segments were graded independently using a 4-point visual scale. Endoscopic and histological inflammation were scored on 4-point scales. At 45 min, a positive correlation was found between endoscopic and scan gradings in individual colon segments when using visual grading and three of the four computer-aided methods (Spearman's rs = 0.30-0.64, P < 0.001). Histological grading correlated with visual grading and with two of the four computer-aided methods at 45 min (rs = 0.42-0.54, P < 0.001). At 4 h, all grading methods correlated positively with both endoscopic and histological assessment. The correlation coefficients were, in all but one instance, highest for the visual grading. As an inter-observer comparison to assess agreement between the visual gradings of two nuclear physicians, 14 additional patients (9 ulcerative colitis, 5 infectious enterocolitis) underwent leukocyte scintigraphy. Agreement assessed using kappa statistics was 0.54 at 45 min (P < 0.001). Separate data concerning the presence/absence of active inflammation showed a high kappa value (0.74, P < 0.001). Our results showed that a simple scintigraphic scoring system based on assessment using the human eye reflects colonic inflammation at least as well as computer-aided grading, and that highly correlated results can be achieved between different investigators.
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Affiliation(s)
- S Almer
- Department of Internal Medicine, Faculty of Health Sciences, Linköping University, Sweden
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31
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Abstract
The nuclear medicine evaluation of the immunocompromised patient with fever of unknown origin may include the use of either labeled leukocytes or Ga-67 citrate, or both, in the search for an infectious focus. In recent years, labeled leukocytes (In-111 or Tc-99m) seem to have been employed preferentially by some. This is especially the case when the abdomen is a suspected site of involvement because of the normal colonic excretion of gallium that may complicate the interpretation of this study. The authors present the case of an immunocompromised patient with the interesting scintigraphic pattern of diffuse large and small bowel uptake of gallium secondary to biopsy proven Yersinia and tuberculous enterocolitis. A review of the recent literature reveals only one other similar case in which Yersinial disease was detected by Ga-67 scintigraphy. The present case illustrates that gallium's avidity for the atypical, less pyogenic, opportunistic infections common in immunocompromised patients justifies its continued use in such settings and, specifically, whenever tuberculosis is suspected.
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Affiliation(s)
- M Brophey
- University of Texas Health Science Center at Houston 77030, USA
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32
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Abstract
We conducted this study to determine if color Doppler ultrasonography can identify increased vascularity associated with gastrointestinal inflammatory conditions and to determine if specific diagnoses can be established based on flow patterns. Twenty-five children with acute right lower quadrant pain and discharge diagnoses of inflammatory bowel processes were examined by color Doppler sonography, as an adjunct to routine gray-scale examinations. Final diagnoses included gastroenteritis (10 cases), Crohn's disease (five cases), neutropenic colitis (four cases), peritonitis (four cases), and Yersinia enterocolitis (two cases). The results of color Doppler sonography were considered positive for inflammation if increased vascularity was demonstrated in the bowel mucosa, muscularis layer, or adjacent tissues. A control group of 19 patients was examined. No sonographic abnormalities were identified in any patients in the control group. Diffuse, concentric wall thickening with increased blood flow centrally within the mucosa was seen in Crohn's disease (60%) and Yersinia enterocolitis (100%), whereas wall thickening with increased transmural vascularity was identified in neutropenic colitis (50%) and Crohn's disease (40%). In contrast, in peritonitis color Doppler sonography showed thickened bowel wall and hypervascularity within peripheral bowel wall or in adjacent soft tissues. No demonstrable bowel vascularity was seen in gastroenteritis. Our experience suggests that mucosal or transmural hypervascularity on color Doppler sonography can be seen with several inflammatory bowel processes, but it is nonspecific. However, color Doppler sonography may aid in differentiating primary bowel disease from extrinsic inflammatory conditions, such as peritonitis.
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Affiliation(s)
- S P Quillin
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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33
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Russel MG, Zeijen RN, Brummer RJ, de Bruine AP, van Kroonenburgh MJ, Stockbrügger RW. Eosinophilic enterocolitis diagnosed by means of technetium-99m albumin scintigraphy and treated with budesonide (CIR). Gut 1994; 35:1490-2. [PMID: 7959211 PMCID: PMC1375032 DOI: 10.1136/gut.35.10.1490] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A patient with a 15 year history of diarrhoea of unknown origin is described. Scintigraphy with technetium-99m labelled albumin suggested albumin loss at the terminal ileum and caecum; subsequent colonoscopic biopsies of these macroscopically normal looking areas showed abundant infiltration with eosinophils. A diagnosis of eosinophilic enterocolitis was made. Treatment with prednisolone had good results, but had to be stopped because of severe side effects. Oral cromoglycate and mesalazine were not effective. Budesonide (CIR), a new topically active corticosteroid with very little systemic effects, was at least as effective as prednisolone without producing side effects.
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Affiliation(s)
- M G Russel
- Department of Gastroenterology, University Hospital Maastricht, The Netherlands
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34
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Abstract
OBJECTIVE Inflammatory bowel diseases produce segmental or diffuse mural thickening of the intestine that can be detected and evaluated by using sonography. The purpose of this study was to evaluate the sonographic findings and determine their diagnostic value in patients with inflammatory bowel diseases. MATERIALS AND METHODS We reviewed sonograms of 81 patients with inflammatory bowel diseases. The findings were compared with those of barium study, colonoscopy, and surgery. Forty-five patients had tuberculous enterocolitis, 13 had ulcerative colitis, eight had Crohn's disease, five had ischemic colitis, two had Behçet's syndrome, and eight had unspecified colitis. Diagnosis was based on surgical and pathologic findings in 23; results of barium study and endoscopic biopsy in 20; and results of barium study, colonoscopic findings, and clinical findings in 38. RESULTS Seventy-two patients (89%) had sonograms that showed segmental or diffuse mural thickening and a paucity of luminal content in the involved bowel. Involved areas were the ileocecal region in the cases of tuberculous enterocolitis and Behçet's syndrome, the left side of the colon in ulcerative colitis, and the colon and terminal part of the ileum in Crohn's disease. In ischemic colitis, the distribution of involved bowel was nonspecific. Sonographic findings correlated well with the findings of barium enema or colonoscopy in terms of the involved segments of the bowel. Mesenteric lymphadenitis, omental thickening, and ascites were frequently observed in cases of tuberculous enterocolitis. CONCLUSION Sonographic evidence of mural thickening of the bowel with a paucity of luminal content may be helpful in the detection of inflammatory bowel diseases. However, the findings are nonspecific, and the differential diagnosis must be related to the specific segment of the bowel involved.
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Affiliation(s)
- J H Lim
- Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul, Korea
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35
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Ma LD, Jones B, Lazenby AJ, Douglas T, Bulte JW. Persistent oral contrast agent lining the intestine in severe mucosal disease: elucidation of radiographic appearance. Radiology 1994; 191:747-9. [PMID: 8184056 DOI: 10.1148/radiology.191.3.8184056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Plain radiographs and computed tomographic scans obtained in a severely neutropenic patient with acute lymphoblastic leukemia and cytomegalovirus-associated enterocolitis revealed a pattern of prolonged mucosal adherence of oral contrast agent to the small bowel. This pattern was seen as long as 16 weeks after administration of contrast agent and has been seen previously only in patients who have received bone marrow transplants. Two sets of intestinal biopsy specimens contained crystals that coated denuded mucosa at the site of ulceration and later were trapped within the lamina propria. Electron diffraction and energy-dispersive radiographic analysis showed that these crystals were composed of barium sulfate.
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Affiliation(s)
- L D Ma
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD 21287
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36
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Wohl I, Schein M. [Neutropenic colitis following chemotherapy for malignancy]. Harefuah 1994; 126:191-3, 239. [PMID: 8168760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Neutropenic colitis (NC) is an inflammatory process of the terminal ileum, cecum and ascending colon which often develops in neutropenic patients following chemotherapy for malignant diseases. A case of NC in 65-year old man who was neutropenic after chemotherapy for chronic lymphatic leukemia, is presented. Early diagnosis on CT-scan and appropriate antibiotic therapy led to prompt resolution of the bowel condition. Physicians who treat patients with malignant diseases should be aware of this potentially lethal condition so that it can be effectively diagnosed and treated.
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Affiliation(s)
- I Wohl
- Surgical Dept. B, Rambam Medical Center, Haifa
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37
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Abstract
The enterocolitis following a pull-through in Hirschsprung's disease can be life-threatening and difficult to distinguish clinically from gastroenteritis and post-operative complications. We reviewed retrospectively the abdominal radiographs in our series to identify specific radiographic characteristics of this syndrome in this population. A total of 55 episodes of enterocolitis with an abdominal series at presentation were located in the files of 43 patients following pull-through surgery for Hirschsprung's disease. There were 15 abdominal series with other complications of Hirschsprung's disease and surgery (seven cases of small bowel obstruction, one of fistula, one of abscess, six of severe constipation) and 71 surveillance follow-up studies. Radiographs were evaluated for bowel dilatation, air-fluid levels, intestinal cut-off sign, speculation, and pneumatosis. The intestinal cut-off sign with two or more air-fluid levels had sensitivity of 68% and specificity of 83%, with a positive predictive value of 0.71 and overall accuracy of 77%. Our review of enterocolitis following pull-through in children with Hirschsprung's disease concludes that the constellation of an intestinal cut-off sign and at least two air-fluid levels on the abdominal series strongly suggests the diagnosis.
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Affiliation(s)
- C E Blane
- Department of Radiology, University of Michigan, Ann Arbor 48109
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38
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Haber MM, Burrell M, West AB. Enterocolic lymphocytic phlebitis. Clinical, radiologic, and pathologic features. J Clin Gastroenterol 1993; 17:327-32. [PMID: 8308222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Venous compromise as a cause of ischemic colitis and enteritis is infrequent. Enterocolic lymphocytic phlebitis, a rare cause of such compromise, to our knowledge has been reported in only three patients. We describe a patient with this condition who had hematochezia and a cecal mass that was mistaken endoscopically and radiologically for carcinoma and required resection. The mass, which was ulcerated, was due to intense submucosal edema. The patient had no history of taking hydroxyethylrutoside, a drug used in Europe in treating varicose veins that has been implicated in all three previously reported cases. This entity is characterized by a mixed T- and B-cell vasculitis affecting veins exclusively in the wall and mesentery of the colon and small bowel, without systemic involvement, leading to fibrointimal proliferation, thrombosis, venous occlusion, and subsequent edema and ischemic necrosis. It should be distinguished from other enterocolic phlebitides, including Behçet disease, systemic lupus erythematosus, and myointimal hyperplasia of mesenteric veins, and can be treated by local excision of the affected bowel.
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Affiliation(s)
- M M Haber
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510-8070
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39
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Affiliation(s)
- K M Dudiak
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905
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40
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Kuwabara Y, Kataoka M, Kureyama Y, Iwata H, Kashima T, Sato A, Shinoda N, Hattori K, Masaoka A. [A case of neutropenic enterocolitis associated with acute myelocytic leukemia diagnosed by ultrasonography]. Nihon Shokakibyo Gakkai Zasshi 1993; 90:1463-6. [PMID: 8320857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Y Kuwabara
- Second Department of Surgery, Nagoya City University Medical School
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41
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Dayan K, Neufeld DM, Lang R, Novis B, Bernheim J, Freund U. [Widespread gastrointestinal CMV infection as the presenting manifestation of AIDS]. Harefuah 1993; 124:124-6, 184. [PMID: 8388359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 53-year-old man is reported who developed a widespread gastrointestinal infection due to cytomegalic (CMV) virus and was found to be suffering from AIDS. He died of overwhelming pulmonary infection. There is need for awareness of the rapid increase of AIDS in our local population, particularly in groups not regarded as at high risk. It is imperative to keep this diagnosis in mind when dealing with patients with gastroenterocolitis not responding to standard treatments. CMV has a broad spectrum of clinical manifestations, from carrier state to life-threatening infection. In the gastrointestinal system it causes inflammation and ulcers in the mucosa that may bleed or perforate. There are increasing numbers of reports of CMV ileocolitis in homosexuals with AIDS. The rate of sero-positive CMV in healthy homosexual populations is 94-100% and in 14% there is active infection. CMV is the main infective agent in patients suffering from AIDS; 90% will develop an infection with this virus and in most cases it will be fatal.
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Affiliation(s)
- K Dayan
- Dept. of Surgery A, Meir General Hospital
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42
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Abstract
Abdominal ultrasonic examination was performed in 14 patients with Schonlein-Henoch purpura (SHP). Thickening of the duodenal wall was observed in nine (82%) of the 11 with such gastrointestinal (GI) symptoms as severe abdominal pain or bleeding. The thickened duodenal wall showed a high echogenicity. Enlargement of the duodenal lumen was seen in seven (64%) patients with GI symptoms. These findings had been observed in four patients before SHP was diagnosed on the basis of the peculiar skin lesions. In three cases of SHP without GI symptoms, those changes were absent. Four cases of ulcerative colitis, three of bacterial enterocolitis (two Yersinia and one Klebsiella), and five without SHP and any GI problems did not exhibit such duodenal abnormalities. On subsequent endoscopic study, mucosal edema and multiple hemorrhagic erosions were seen, especially at the second portion of the duodenum in two cases of SHP. Biopsy specimens from the duodenum of those cases showed leukocytoclastic vasculitis, suggested by the ultrasound (US) findings. It is important to consider the duodenal changes carefully when US is performed in patients with severe GI symptoms of unknown origin. The characteristic duodenal findings described suggest the differential diagnosis of SHP, which usually requires no surgical intervention.
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Affiliation(s)
- S Kagimoto
- Department of Pediatrics, National Defense Medical College, Saitama, Japan
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43
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Abstract
The feasibility of the use of indium 111 oxine-labeled autologous leukocytes for the diagnosis of ischemic enterocolitis in vivo was examined in an experimental model of ischemia in dogs. A 30-cm segment of small intestine was devascularized by ligating the arteries and veins from the last arcade in 7 dogs. A sham operation was performed in 3 control dogs. 111In oxine-labeled autologous white blood cells were infused 3.5 hours after operation. Anterior and lateral nuclear scanning was performed at 6 and 24 hours postinfusion with a gamma camera equipped with a low-energy magnifying multihole collimator. The animals were killed after 24 hours. The gross and microscopic appearance of the bowel was evaluated. The radioactivity in the serial specimens of the bowel was measured. In vivo scans were positive (ie, increased uptake in the bowel loop) in all dogs with intestinal ischemia at 6 and 24 hours. No significant uptake was noted in control dogs. Rectilinear scan of the bowel removed at autopsy showed a correlation between the area of infarction and tracer accumulation. In addition, there was a progressive decrease in uptake of 111In oxine from the center of the ischemic lesions to the periphery. Forty percent of the total radioactivity was measured at the center of the lesion, whereas only 6.5% was present at 22.5 cm from the center. Thus the ratio between the ischemic and normal tissue was 10:1 (range, 6.5 to 16). These studies demonstrate that 111In oxine-labeled autologous white blood cells can be used for the diagnosis of ischemic enterocolitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J De Agustin
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
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44
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Abstract
Ultrasound examination was performed in 90 patients with varying bowel pathology. Ultrasound reliably demonstrated thickening of the bowel. In addition, the pattern of abnormality seen in Crohn's disease and ulcerative colitis was different, and corresponded to the pathological changes seen in these disease processes. The pattern of bowel abnormality seen in other bowel diseases with an inflammatory aetiology generally corresponded to either the Crohn's or ulcerative colitic pattern. The appearances are described, together with findings in other non-neoplastic diseases of the bowel.
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Affiliation(s)
- K T Khaw
- Department of Radiology, St George's Hospital, London
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Peene P, Van Steen A, Ponette E. Yersinia enterocolitis. J Belge Radiol 1989; 72:524-5. [PMID: 2621208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Demaerel P, Ponette E, Lacquet F, Verbist L, Rutgeerts P, Baert AL. The role of radiology in Campylobacter enterocolitis. ROFO-FORTSCHR RONTG 1989; 150:551-5. [PMID: 2541480 DOI: 10.1055/s-2008-1047075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A series of 18 patients with diarrhoea and positive stool cultures for Campylobacter jejuni is presented. The most important radiological features were thickening of ileal mucosal folds, of interhaustral indentations and of the ileocaecal valve, lymphoid hyperplasia and microulcerations. Radiology, as well as endoscopy, are both nonspecific in Campylobacter jejuni enterocolitis. The importance of radiology is to exclude more typical features of other causes of inflammatory bowel diseases. Moreover, before the result of the stool culture is available, the radiological features should suggest the suspicion of an acute infectious enterocolitis by Campylobacter jejuni as possible diagnosis.
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Affiliation(s)
- P Demaerel
- Department of Radiology, University Hospitals, K. U. Leuven
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Macaigne O, Bonnière P, Lecouffe P, Deveaux M, Marchandise X, Cortot A, Paris JC. [Intestinal scintigraphy with labelled sucralfate in cryptogenetic enterocolitis: a broken promise]. Gastroenterol Clin Biol 1989; 13:435-6. [PMID: 2737404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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48
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Ueyama T, Hirata N, Motooka M, Kitagawa S, Masuda K, Haraguchi Y, Mine H, Koga Y. [Yersinia enterocolitis--report of two cases]. Rinsho Hoshasen 1989; 34:273-6. [PMID: 2754826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We reported two cases of terminal ileitis caused by Yersinia enterocolitica (Y.e.). Y.e. was proven by stool culture in each case. They were admitted to the hospital complaining abdominal pain. They are examined by X-ray and endoscopy in the different time, and their examination revealed edema, coarse mucosa and varioliform elevated lesions with the passage of time.
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Yonezawa Y. [Roentgenographic and macroscopic study on experimental ischemic enterocolitis--especially on time-course of its change]. Igaku Kenkyu 1988; 58:427-38. [PMID: 3252683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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50
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Taylor GA. Cow's milk protein/soy protein allergy: gastrointestinal imaging. Radiology 1988; 167:866. [PMID: 3363156 DOI: 10.1148/radiology.167.3.3363156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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