Optimized protocol for diagnosis of acute ileitis.
OBJECTIVE
Suspected acute ileitis (AI) is a poorly defined clinical condition with multiple causes; its diagnostic protocol has not been standardized properly. We performed a prospective evaluation of the incidence and causes of AI to create a standard protocol for diagnosis.


METHODS
The definition of AI included abdominal pain, diarrhea, fever, and at least 1 confirmatory imaging method (abdominal computed tomography scan or ultrasound) showing pathologic changes in the terminal ileum that indicated ileal inflammation. We studied all patients with a presumptive diagnosis of AI seen in the Emergency Room at the Ramón y Cajal Hospital in Madrid, from March 2005 to May 2007, according to a pre-established protocol. Sixty-six patients with primary AI were followed up for at least 6 months.


RESULTS
An infectious cause was found in 33.3% of cases; the most frequently detected microorganism was Yersinia spp. A gynecologic condition was identified in 9.1% of cases initially diagnosed as AI, representing 13.95% of the cases among female patients. Crohn's disease was identified in 12.1% of patients. The diagnostic protocol led to negative results in 33.4% of the patients; 6.1% of patients did not complete the study. The initial diagnosis did not change among any of the patients during the follow-up period.


CONCLUSIONS
This protocol led to a definitive diagnosis of AI in more than 60% of potential cases. The most common cause was acute infection. About 10% of cases were of gynecologic origin and about 12% of patients presented with Crohn's disease.
Garrido
Elena
E
IBD Clinic, Gastroenterology Department, Ramón y Cajal Hospital, Madrid, Spain. elenagarridogomez@hotmail.com
Sanromán
Antonio L
AL
Rodríguez-Gandía
Miguel A
MA
Rivero
Miguel
M
Royuela
Ana
A
Moreira
Víctor
V
Milicua
José María
JM
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003938:Diagnostic Techniques, Digestive System / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007079:Ileitis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013030:Spain; D055815:Young Adult