Gastrointestinal: Virtual CT ileoscopy in terminal ileitis
Article first published online: 29 JUL 2009
© 2009 The Authors. Journal compilation © 2009 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 24, Issue 7, page 1307, July 2009
How to Cite
Kalra, N., Rana, S., Bhasin, D. and Khandelwal, N. (2009), Gastrointestinal: Virtual CT ileoscopy in terminal ileitis. Journal of Gastroenterology and Hepatology, 24: 1307. doi: 10.1111/j.1440-1746.2009.05958.x
- Issue published online: 29 JUL 2009
- Article first published online: 29 JUL 2009
Despite dramatic improvements in medical imaging, it may still be difficult to evaluate the terminal ileum. In India, common reasons for ileal imaging include ileal tuberculosis and Crohn's disease. Both disorders can result in morphological changes in the mucosa, ileal wall and ileal mesentery. Other disorders that can affect the terminal ileum include radiation ileitis, ulceration induced by non-steroidal, anti-inflammatory drugs and infections such as cytomegalovirus. There are also a variety of neoplasms including carcinoid tumors, stromal tumors, lipomas and lymphomas. Imaging options for the terminal ileum include barium follow-through studies, tube enteroclysis, peroral pneumocolon, computed tomography and magnetic resonance imaging. The terminal ileum can also be visualized by capsule endoscopy and by ileoscopy at the time of colonoscopy. However, ileal strictures are a contraindication for capsule endoscopy and can create difficulties for the endoscopist. We describe successful virtual CT ileoscopy of the terminal ileum in a patient with a tight ileal stricture. As far as we are aware, virtual CT ileoscopy of the terminal ileum after air insufflation has not been reported previously.
A 40-year-old woman presented with a distal small bowel obstruction that improved with conservative management. A barium follow-through study showed a terminal ileal stricture just proximal to the ileocecal valve. No abnormalities were detected at colonoscopy. At ileoscopy, the stricture was identified but the colonoscope could not be passed through the stricture. However, it was possible to pass a guidewire across the stricture and perform balloon dilatation. There was mucosal ulceration in the region of the stricture as shown in Figure 1. Virtual ileoscopy was performed after the injection of approximately 400 ml of air through the colonoscope. The procedure was performed with a multidetector CT scanner (Light Speed Qxi plus, GE Medical Systems, Milwaukee, USA) with 3.75 mm collimation and 2.5 mm overlap (120 kVp, 70 mA, 0.8 sec rotation time, 15 mm table increment per rotation). Post-processing was done to obtain 3-dimensional endoluminal images. Virtual navigation revealed mucosal irregularity as shown in Figure 2. Axial and coronal images revealed a stricture, 2.5 cm in length, with circumferential mural thickening and mesenteric fat stranding (arrows, Figure 2 inset). Ileal biopsies revealed chronic inflammation consistent with Crohn's disease and the patient is now asymptomatic on salicylates after follow-up for 12 months.