title: Crohn's disease of the proximal small intestine: radiologic findings in 55 patients.
abstract: Radiographs of the upper gastrointestinal tract and the small bowel of 55 patients were reviewed to identify changes associated with proximal enteric Crohn's disease. Five patients had gastroduodenitis, 18 duodenitis, 14 jejunitis and 18 jejunoileitis. Nineteen had previously undergone ileocecal resection. The terminal ileum was spared in 11 of the 36 patients who had not undergone ileocecal resection; of these, 9 had jejunoileitis, 1 jejunitis and 1 jejunitis secondary to colitis with colojejunal fistulas. In just over 80% of the patients with jejunal disease and all the patients with primary jejunal disease in whom the terminal ileum was spared, the condition developed before the patients reached 30 years of age. Duodenal disease was not associated with any particular age group, and duodenitis was invariably a "skip" lesion in patients with disease of the terminal ileum. The diagnosis of proximal enteric Crohn's disease depended on the presence of one or more characteristic lesions in the jejunum or terminal ileitis associated with a duodenal or jejunal abnormality. Ulceration occurred in 88% of the patients with a diseased terminal ileum but was less common in patients with a diseased duodenum (occurring in 43%), jejunum (in 53%) or proximal ileum (in 57%). Fistulas in the terminal ileum complicate ulceration in 10% to 26% of patients, and sinuses complicate ulceration slightly more often, but proximal enteric fistulas or sinuses occurred in only four (7%) of the patients described here.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Radiology, University of Toronto, Ont.
authors.forename: A H
authors.initials: AH
authors.lastname: Zalev
authors.forename: E J
authors.initials: EJ
authors.lastname: Prokipchuk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003092:Colitis / Q000000981:diagnostic imaging; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004382:Duodenitis / Q000000981:diagnostic imaging; D004751:Enteritis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007079:Ileitis / Q000000981:diagnostic imaging; D007579:Jejunal Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography