Chronic Non-granulomatous Ulcerative Jejunoileitis Assessed by Wireless Capsule Endoscopy

Hyung Hun Kim, You Sun Kim, Kyung Sun Ok, Soo Hyung Ryu, Jung Hwan Lee, Jeong Seop Moon, Hyuck Sang Lee, Hye Kyung Lee
2010 Korean Journal of Gastroenterology  
Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions.
more » ... capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient's abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection. (Korean J Gastroenterol 2010;56:382-386) addition, celiac sprue has never been reported in Korea. We also considered cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) in the differential diagnosis. CMUSE is characterized by intermittent bouts of intestinal obstruction, ulcerative stenoses of the small bowel relapsing after surgical resection, and steroid sensitivity. Unlike chronic non-granulomatous ulcerative jejunoileitis, CMUSE has a normal villous architecture and no malabsorption. 6 In our case, the microscopic examination showed focal villous atrophy, and obvious hypoalbuminemia was present, ruling out CMUSE. We concluded that our patient had idiopathic non-granulomatous ulcerative jejunoileitis after ruling out other possible pathologic conditions, such as Crohn's disease, tuberculosis, fungal infections, corticosteroid therapy, intestinal lymphoma, and celiac sprue. 4 Chronic non-granulomatous jejunoileitis is a rare disease entity with unknown etiology, typically presenting with abdominal pain, diarrhea, and malabsorption. The usual findings of chronic non-granulomatous ulcerative jejunoileitis are small bowel thickening or edema and hyperemia of the serosa, most often of the jejunum. Multiple strictures with proximal intestinal dilatation are common. Ulcers are typically superficial and often perpendicular to the long axis of the bowel, 7 as in our case. Most cases remain undiagnosed until laparotomy, which is often precipitated by complications, such as obstruction, hemorrhage, or perforation. 7 Our patient had chronic abdominal pain and lower extremity pitting edema due to hypoalbuminemia, despite intermittent albumin infusions. The 99m-Tcalbumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy, and the fecal occult blood test was strongly positive. However, we were unable to verify lesions on small bowel follow-through. WCE is known to facilitate the detection and assessment of ulcerated mucosal lesions located in the small bowel. 8 We confirmed the ulcerative and stenotic lesions by WCE. Three patients with chronic non-granulomatous jejunoileitis have been reported in Korea, and their manifestations were similar to the manifestations in our patient: (abdominal pain, protein-losing enteropathy, and anemia).
doi:10.4166/kjg.2010.56.6.382 pmid:21173563 fatcat:5itadlkjsbfxzphey6b4b77jhu