© 2002 The Fellowship of Postgraduate Medicine
Terminal ileal stricture
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The small bowel enema shows normal jejunum. The ileum is shortened in its distal portion and uniformly narrowed with a smooth outline; the ileocaecal junction is well delineated and the caecum is normal.
The differential diagnosis of ileal stricture includes tuberculosis, Crohn’s disease, pelvic inflammation, ischaemia, radiation enteritis, carcinoid infiltration, lymphoma, and diffuse enteropathy—that is, disorders where there is inflammation, infiltration, or oedema of the small bowel. History and clinical findings in this case did not contribute to the diagnosis.
Enteroscopy/terminal ileoscopy is the investigation of choice. In active Crohn’s disease, the terminal ileum shows patchy asymmetrical and heterogenous mucosal lesions. Ulcers which may be aphthoid, superficial, or deep are seen surrounded by normal mucosa. Tuberculoid granuloma is the most specific finding on histology apart from infiltration of lamina propria by lymphocytes and plasma cells with aggretates of lymphocytes near the base of the crypts. In the present case, the
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