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.

 

Scroll to top

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Chiorean L, Schreiber-Dietrich D, Braden B, Cui X, Dietrich CF.. Transabdominal ultrasound for standardized measurement of bowel wall thickness in normal children and those with Crohn’s disease Med Ultrason. 2014
• 2 van Wassenaer EA, de Voogd FAE, van Rijn RR, van der Lee JH, Tabbers MM, van Etten-Jamaludin FS. et al. Bowel ultrasound measurements in healthy children ---- systematic review and meta-analysis Pediatr Radiol. 2020.
• 3 Puylaert J.. Ultrasonography of the acute abdomen: gastrointestinal conditions Radiol Clin North Am. 2003
• 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

Publication History

Article published online:
27 March 2025