Ruptured terminal ileum from intestinal TB
Today we discussed ileal inflammation (AKA 'terminal ileitis') and some related issues. A few points:
In any patient presenting with RLQ pain, always exclude life-threatening conditions:
-Appendicitis, diverticulitis with or without abscess
-Strangulated hernia
-Ectopic pregnancy
-Pelvic inflammatory disease
-Others presenting atypically (e.g. ruptured AAA, bowel obstruction, etc)
Specific causes of ileitis:
Infectious:
Bacterial: yersinia, campylobacter, typhoid (from Peyer's patch enlargement), actinomyces Mycobacterial: TB, or non-tuberculous mycobacteria
Parasitic: amebiasis- can present exactly like Crohn's
Viral: CMV
Typhlitis (aka neutropenic enterocolitis or ileocecal syndrome)- seen in immunocompromised pts
Inflammatory:
Crohn's disease
Microscopic colitis
Neoplastic:
Small bowel lymphoma
Vasculitic:
Henoch-Schonlein purpura (rarely!)
Intestinal TB
Difficult to diagnose; need high index of suspicion;
non-specific chronic abdominal pain is the most common symptom, with constitutional symptoms. Palpable mass in 25-50% of patients. May see ascites, which helps to distinguish from some of the above causes of ileitis. Treatment is similar to pulmomary TB, and usually responds well
Links:
Click here for a CMAJ review of extrapulmonary TB
Click here for a NEJM clinical pathological conference where the differential of ileitis is discussed
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