| Objectives: To summarize the types,clinical features,endoscopic and pathological features of terminal ileum lesions,evaluate the value of colonoscopy and pathological examination in the diagnosis of terminal ileum lesions,discuss the differential diagnosis of intestinal tuberculosis and Crohn’s disease by a retrospective analysis of terminal ileum lesions in 613 cases so that our understanding of these diseases were strenthened.Methods: The data of terminal ileum lesions in 613 cases which were checked out by the examination of the colonoscopy at our digestive endoscopy room from Jun.2006 to Jun.2015 were collected.SPSS 17.0 Statistics software was used to analyze and summarize its clinical characteristics,endoscopic features,pathological features and treatment follow-up.Results:1 The study included 383 cases of male and 230 cases of female(1.67/1).The mean age was 42.57±16.13(range 4-83).Abdominal pain accounted for 58.24%(357/613),diarrhea accounted for 25.77%(158/613),bloating accounted for 15.33%(94/613),blood in the stool1 accounted for 3.38%(82/613)and fever accounted for 6.36%(39/613).2 The total detection rate of terminal ileum lesions was 2.63%(613/23331).13 kinds of diseases were clearly diagnosed,which included 289 cases of terminal ileitis accounting for 47.15%(289/613);153 cases of nonspecific small bowel ulcer accounting for 24.96%(153/289);29 cases of intestinal tuberculosis accounting for 4.73%(29/613);28 cases of ulcerative colitis accounting for 4.57%(28/613);21 cases of eosinophilic gastroenteritis accounting for 3.43%(21/613);14 cases of Crohn’s disease accounting for 2.28%(14/613);12 cases of abdominal type henoch-schonlein purpura accounting for 1.96%(12/613);11 cases of polyp accounting for 1.79%(11/613);4 cases of lymphoma accounting for 0.65%(4/613);4 cases of ischemic bowel disease accounting for 0.65%(4/613);3cases of intestinal Behcet’s disease accounting for 0.49%(3/613);1 case of adenocarcinoma of the small intestine accounting for 0.16%(1/613);1 case of systemic lupus erythematosus accounting for 0.16%(1/613).43 cases accounting for 7.01%(43/613)were not diagnosed.3 The terminal ileum lesions were divided into 5 types of morphology by the colonoscopy:(1)congestion,edema,erythema: 369 cases accounting for 60.20%(369/613);(2)erosion: 324 cases accounting for 52.86%(324/613);(3)ulcer:251 cases accounting for 40.95%(251/613);(4)hyperplasia:20 cases accounting for 3.26%(20/613);(5)narrow: 12 cases accounting for 2.00%(12/613).4 The diagnostic coincidence rate of endoscopy and pathology: The diagnostic coincidence rate of terminal ileitis,polyp,lymphoma and adenocarcinoma of the small intestine were 100%.The rate of ulcerative colitis was 82.14%.The rate of nonspecific small bowel ulcer was 81.70%.The rate of intestinal tuberc ulosis was 55.17%.The rate of Crohn’s disease was 42.85%.The rate of intestinal Behcet’s disease was 33.33%.The rate of eosinophilic gastroenteritis was 28.57%.The rate of abdominal type henoch-schonlein purpura was 25.00%.The rate of ischemic bowel disease was 25.00%.The rate of systemic lupus erythematosus was 0%.5 570 of 613 patients of terminal ileum lesions were followed-up successfully.The rate of follow-up was 92.99%(570/613).The revisit time ranged from 6 months to 9 years.43 cases were lost to follow-up accounting for 7.01%.6 In the comparison of clinical symptoms of 29 cases of intestinal tuberculosis and 14 cases of Crohn’s disease,the difference of blood in the stool in two groups was statistically significant(P<0.05).Blood in the stool was more common in Crohn’s disease.In the comparison of endoscopic manifestations of intestinal tuberculosis and Crohn’s disease,the difference of pebbles levy,segmental change,circular ulcer,longitudinal ulcer in two groups was statistically significant(P<0.05).Pebbles levy,segmental change,longitudinal ulcer were more common in Crohn’s disease.Circular ulcer was more common in intestinal tuberculosis.In the comparison of pathological features of intestinal tuberculosis and Crohn’s disease,the difference of caseous granuloma in two groups was statistically significant(P<0.05).Caseous granuloma was in only intestinal tuberculosis.Conclusions:1 Electronic colonoscopy combined with pathological examination was the most important diagnostic method of terminal ileum lesion,but we should pay attention to the clinical history,laboratory examination,diagnostic treatment,and other comprehensive means.2 The terminal ileum lesions were most benign lesions,mainly terminal ileitis and nonspecific intestinal ulcer.Malignant lesions were rare,mainly lymphoma and adenocarcinoma of the small intestine.3 The differential diagnosis of intestinal tuberculosis and Crohn’s disease in the clinical symptoms,endoscopic manifestations and pathological features is feasible,but we need multi center,large sample in-depth study and summary for further research.4 Follow-up was indispensable in the diagnosis of terminal ileum lesions,so more attention would be paid to it. |
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