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P130. Terminal ileitis: Not always Crohn's

J. Ngu1, K. Sng1

1Changi General Hospital, General Surgery, Singapore, Singapore

Background: Although Crohn's disease remains the commonest cause of terminal ileitis, other aetiologies should also be entertained. Common differentials include bacterial and parasitic infections, malignant lesions, radiation-induced ileitis, vasculitides or autoimmune disorders. Certain basic investigations should be included as a routine in order to avoid misdiagnosis.

Methods: From January 2003 to January 2011, fifty-one patients were diagnosed with terminal ileitis in a tertiary hospital. We reviewed their presentation, method of diagnosis, treatment, and outcomes.

Results: The mean age of our patients was 40.9 years old. Majority were male (n = 33, 64.7%), and ethnic distribution corresponded to that of our local populace. Only 39.2% of patients were diagnosed with Crohn's disease. Haematological and stool investigations were performed, but the tests done were not uniform and most patients were treated empirically for ileitis without identifying the exact aetiology behind their condition. Amongst those evaluated, none had tuberculosis or parasitic infections, and only two patients had pathogens isolated in their stools (Shigella, Salmonella). Most cases were diagnosed with terminal ileitis based on CT scan findings (n = 41, 80.4%). Twenty-three patients had colonoscopic evaluation either inpatient or on an outpatient basis – most biopsies confirmed the presence of chronic inflammation; no cases of malignancy detected.

Treatment generally involved antibiotics and bowel rest – 94.1% received antibiotics regardless of underlying aetiology. The median length of hospitalisation was 5.0 days. Only four patients underwent surgery for failure of conservative treatment. Patients diagnosed with Crohn's disease received a course of steroids and immune-modulation therapy, with long-term follow-up upon discharge. Amongst patients with recurrence, four were known cases of Crohn's disease, one was diagnosed with Crohn's only after the second presentation, and one was not found to have a specific underlying aetiology.

Conclusions: Patients with terminal ileitis often have underlying inflammatory bowel disease. These patients will require immunosuppression therapy and immune-modulation therapy, in addition to long-term follow-up. There are nonetheless other aetiologies associated with terminal ileitis, and there should be a standardised set of investigations to evaluate patients thoroughly. The importance of diagnosis lies in appropriate immune-therapy for Crohn's and to avoid missed diagnosis of this chronic ailment.