Small Bowel Lesions Mimicking Crohn’s Disease

Abstract

The recognition of a granulomatous disease of the terminal ileum, distinct from tuberculosis, dates back over 85 years and perhaps much farther, but over the past decades, many other clinical pathologic entities have been described that are neither tuberculosis nor Crohn's eponymous regional enteritis. In recent years, the catalog of lesions mimicking Crohn's disease of the small bowel and proposals for differential diagnosis and treatment have expanded to include newly reported appendiceal pathology, primary cancers and lymphomas of the intestine, unexpected metastases from distant organs, unusual infections, vasculitides and other ischemic conditions, Behçet's disease, endometriosis, and drug reactions. A diagnosis of Crohn's disease should not be a reflex action in the face of small bowel structural or inflammatory lesions without consideration of pathology in adjacent organs, primary and metastatic lesions of the small intestine, infections, vascular diseases, infiltrative diseases, drug injury, or other "idiopathic" conditions.

Retrograde enteroclysis by double balloon enteroscopy in a patient with blunt abdominal trauma: small bowel stricture, intraluminal vascular lesion and Crohn�s disease

“…SB injuries from blunt abdominal trauma are uncommon (1-5%) (1,2). Sometimes, ischemic lesions of the digestive tract after a trauma occur over another disease that was not suspected until then (3). DBE allows the entire of the SB to be accessed and also offers the combination of enteroclysis and tattooing that can help to find the lesion during laparoscopy.…”

Personalized Treatment for Crohn’s Disease: Current Approaches and Future Directions

“…The first was the Rome Classification which was proposed by the International Working Party in 1991 and included disease extent, anatomical location, behavior, and operative history. 43 This was revised in 1998 in Vienna at the World Congress of Gastroenterology by including age of onset as well as disease location and behavior. 44 This classification was further updated in 2005 to what is known as the Montreal Classification and includes a pediatric age group subset and is the most commonly used classification today ( Table 3 ).…”

Isolated nonspecific terminal ileitis: prevalence, clinical evolution and correlation with metachronous diagnosis of Crohn’s disease: a retrospective study and review of the literature

“…It may be related to drugs, in particular nonsteroidal anti-inflammatory drugs (NSAID) [ 8 - 10 ], intestinal infections [ 11 - 14 ], vascular disorders [ 15 , 16 ], and neoplasms [ 17 - 19 ], or may rarely occur in the context of spondyloarthropathies [ 20 ] and infiltrative diseases [ 21 , 22 ]. The term “nonspecific terminal ileitis” is used for cases in which a definite cause of isolated terminal ileitis cannot be identified and ileal biopsies do not lead to a specific diagnosis [ 23 , 24 ].…”