Kumar Amit, Rana Surinder S, Nada Ritambhra, Kalra Naveen, Sharma Ravi K, Dutta Usha, Gupta Rajesh
Department of Gastroenterology Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India.
Department of Histopathology Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India.
JGH Open. 2018 Oct 22;3(1):46-51. doi: 10.1002/jgh3.12103. eCollection 2019 Feb.
Clinical significance of ileocecal thickening on computed tomography (CT) is uncertain. We conducted this prospective study to determine the clinical relevance of ileal and/or cecal thickening on CT.
All patients with ileocecal thickening on CT were prospectively evaluated with ileocolonoscopy, biopsy, and other relevant investigations.
Fifty patients (29 males, mean age 36.8 ± 13.21 years) were studied. Thirty nine (78%) patients presented with abdominal pain. On CT, 46 (92%) had a thickened wall of terminal ileum, 25 (50%) cecum, and 21 (42%) of both cecum and ileum. The mean wall thickness of ileum and cecum on CT was 7.23 + 3.2 mm and 5.5 + 3.1 mm, respectively. Final diagnosis was tuberculosis in 24 (48%) patients, Crohn's disease (CD) in 10 (20%), and adenocarcinoma in 1 patient. Colonoscopy demonstrated abnormal findings in 41 patients (82% patients with mucosal ulcerations being most common ( = 20 (40%). Of 15 (30%) patients with ileocecal bowel wall thickening, 4 (8%) patients had normal colonoscopy and histopathology (incidental ileocecal wall thickening), and in the remaining 11 patients, histopathology showed non-specific findings and these patients were asymptomatic without any specific treatment on last follow up ranging from 3 to 24 months. Involvement of cecum with ileocecal junction, ascending colon involvement, peri-ileocecal stranding, and long-segment stricture was significantly more common in patients with underlying disease as compared to nondiseased patients ( < 0.05).
A majority of patients with ileocecal wall thickening on CT have an underlying disease and should be further investigated by ileocolonoscopy and biopsy.
计算机断层扫描（CT）显示的回盲部增厚的临床意义尚不确定。我们开展了这项前瞻性研究，以确定CT上回肠和/或盲肠增厚的临床相关性。
对所有CT显示回盲部增厚的患者进行前瞻性的回结肠镜检查、活检及其他相关检查。
共研究了50例患者（29例男性，平均年龄36.8±13.21岁）。39例（78%）患者有腹痛症状。CT检查显示，46例（92%）患者末端回肠壁增厚，25例（50%）盲肠壁增厚，21例（42%）盲肠和回肠壁均增厚。CT上回肠和盲肠的平均壁厚度分别为7.23 + 3.2毫米和5.5 + 3.1毫米。最终诊断为结核病的患者有24例（48%），克罗恩病（CD）10例（20%），腺癌1例。结肠镜检查发现41例患者（82%）有异常表现，其中黏膜溃疡最为常见（=20例（40%））。15例（30%）回盲肠肠壁增厚的患者中，4例（8%）患者的结肠镜检查和组织病理学结果正常（回盲肠壁增厚为偶然发现），其余11例患者的组织病理学显示非特异性结果，这些患者无症状，在最后一次随访（随访时间为3至24个月）时未接受任何特殊治疗。与无基础疾病的患者相比，患有基础疾病的患者盲肠累及回盲部交界处、升结肠受累、回盲部周围条索状影及长段狭窄更为常见（P<0.05）。
大多数CT显示回盲肠壁增厚的患者患有基础疾病，应进一步通过回结肠镜检查和活检进行评估。
