The relationship between inflammatory and serosal connective tissue changes in ileal Crohn's disease: evidence for a possible causative link

Abstract

The relationship between the gross connective tissue and in¯ammatory changes in ileal Crohn's disease remains unclear. This study investigated 20 patients undergoing ileal resection for Crohn's disease and 20 normal controls. The specimens were blocked in 1 cm serial sections and fully examined, including fresh morphometry and documentation of a range of pathological features. Pathological features of disease showed uniform distributions within affected segments, although specimens showed different patterns and severity of af¯iction. Serosal fat wrapping (FW) was present in all cases and was signi®cantly greater than normals [mean 63.5% (SD 27.8) vs. 21.0% (6.4), p<0.001], as was mesenteric thickening (MTh) [mean 18.0 mm (SD 11.1) vs. 5.9 mm (2.2), p<0.001]. The extent of FW correlated signi®cantly with the degree of acute and chronic in¯ammation (r s =0.32 and 0.23 respectively, p<0.01), particularly the extent of transmural in¯ammation in the form of lymphoid aggregates (r s =0.35, p<0.01). MTh did not correlate with any features studied. These ®ndings support the hypothesis that serosal connective tissue changes in Crohn's disease are related to the local effects of underlying chronic in¯ammatory in®ltrates. Full thickness, radial samples from a grossly affected area are representative of the histopathological features present in a diseased segment as a whole.

Inhibition of CCL1-CCR8 Interaction Prevents Aggregation of Macrophages and Development of Peritoneal Adhesions

“…These Crohn's disease lesions involve the intestinal serosa and mesentery. The characteristic changes in the serosal surface, including fat wrapping, correlate directly with overall extent of inflammatory changes: the stricture of the intestine (10,11), the depth of lymphoid aggregate penetration, and the number of lymphoid aggregates in the underlying ileal wall (12). These observations suggest that inflammation of viscera is not limited to the organ, but provokes responses in the peritoneal cavity as well.…”

Diagnostic Performances of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Fibrosis and Post-Operative Endoscopic Recurrence in Crohn’s Disease

“…The slices were then stained with hematoxylin-eosin assay, examined by light microscopy at increasing magnifications of x20, x40 and x100 hpf and were graded according to criteria proposed by scores of Borley et al [15] & Chiorean et al [16].…”

A rare cause of acute abdomen: ruptured acquired jejunoileal diverticulitis in a patient with Crohn's disease

“…However, Crohn's disease has been reported to be associated with Meckel's diverticulum (6) Also, it has been reported to result in several gastrointestinal changes including motility and serosal connective tissue changes that are considered to be the important factors in the development of diverticula. (7,8) …”

“…Although several factors have been advocated in the pathogenesis of acquired jejunoileal diverticulosis, motility disorders and connective tissue derangements of the intestinal wall are considered to be the primary factors in the development of the disease. Crohn's disease is strongly associated with several motility, serosal connective changes and inflammatory polyps of the small intestine (7,9). In this present case, Crohn's disease may be considered to be one of the factors in the development of the diverticulosis.…”

“…CT findings include nonspecific signs such as an inflammatory mass containing gas and feces-like material, and edema in the surrounding tissue such as intraperitoneal fat or fascial layers (5,7). More specifically, a focal area of asymmetrical small bowel wall thickening or intraluminal contrast enhanced outpouching on the mesenteric side of the bowel may be seen, the presence of which may be Basic Clin Sci 2013; 2: 89-94…”