Distinguishing Infectious and Inflammatory Etiologies in Terminal Ileitis: A Role for Ultrasound

Aims Differentiating between infectious and inflammatory bowel disease (IBD)-related terminal ileitis (TI) is a significant clinical challenge. This study aimed to identify key differences in the clinical presentation and ultrasonographic features of TI of infectious and IBD etiologies [1] [2] [3] [4].

Methods A retrospective, single-center cohort study was conducted at the gastroenterology emergency department of a tertiary hospital. Patients diagnosed with TI via abdominal ultrasound and/or computed tomography (CT) between January 2021 and December 2023 were included. Data on clinical presentation, laboratory results, imaging findings, and final diagnosis were collected and analyzed.

Results Forty-four patients were included, with presumed infectious ileitis accounting for 86.4% of cases, and IBD-related ileitis accounting for 13.6%.

• Patients with infectious ileitis had a mean age of 44.5±21.6 years, while those with Crohn's ileitis had a mean age of 36±12.3 years.

• Laboratory findings in infectious ileitis showed mean C-reactive protein (CRP) levels of 8.9±7.7 mg/dL, leukocytes 9.2±4.1×10⁹/L, neutrophils 6.8±3.3×10⁹/L, hemoglobin 14±1.6 g/dL, and platelets 232±73×10⁹/L. Corresponding values for Crohn’s ileitis were CRP 9.7±5.6 mg/dL, leukocytes 12±2.3×10⁹/L, neutrophils 7.7±3.5×10⁹/L, hemoglobin 13.6±1.8 g/dL, and platelets 366±65×10⁹/L, with no statistically significant differences between groups.

Symptomatically:

• Infectious ileitis patients had less frequent vomiting (29% vs. 50%) but more frequent diarrhea (63% vs. 17%). Fever was reported similarly in both groups (34% vs. 33%).

  Ultrasonographic findings:

• Infectious ileitis showed a mean ileal wall thickness of 5.2±3.3 mm over 6.8±4.7 cm, whereas Crohn’s ileitis demonstrated 3.3±4.1 mm over 11.4±13.4 cm, with no statistically significant differences.

• Infectious ileitis was less often associated with peritoneal effusion (53% vs. 67%) but exclusively presented with lymphadenopathy (42%). Colonic involvement (34% vs. 33%) and mesenteric fat hypertrophy (50% vs. 50%) were similarly observed in both groups.

Conclusions Ultrasound findings, when integrated with clinical and laboratory data, can assist in distinguishing between infectious and IBD-related TI. Infectious ileitis appears to be associated with greater wall thickness and shorter segment involvement, while IBD-related ileitis is linked to more frequent peritoneal effusion and absence of lymphadenopathy. These distinctions are critical for tailoring diagnostic and therapeutic approaches.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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• 4 Molina Gutiérrez MÁ, Pérez Vigara A, Martínez-Ojinaga Nodal E, Bueno Barriocanal M, López López R.. Valor de la ecografía abdominal en la evaluación de la ileítis infecciosa aguda en ninos An Pediatr (Barc). 2022