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.
