Ileocecal thickening: Clinical approach to a common problem

Abstract

Ileocecal thickening (ICT) is a common finding on radiological imaging. It can be caused by a variety of inflammatory, infectious, or neoplastic conditions, and evaluating a patient of ICT can be a challenging task. Intestinal tuberculosis (ITB), Crohn's disease (CD), and adenocarcinoma are the most common causes. Enteric bacterial infections, cytomegalovirus, histoplasmosis, amebiasis, systemic vasculitis, lymphoma, etc. should be suspected in appropriate clinical settings. However, it could often be a spurious or nonspecific finding. A thickness of more than 3 mm in a normally distended small bowel is usually considered abnormal. Detailed evaluation of imaging of the site and extent of thickening; the degree and pattern of thickening; and the associated findings, such as degree of fat stranding, fibrofatty proliferation, adjacent lymph nodes, and solid organ involvement, should be performed. Ileocolonoscopy is an important tool for diagnosing and obtaining samples for tissue diagnosis. Histopathology is usually the gold standard for diagnosis, although-not uncommonly-findings could be nonspecific, and reaching a definitive diagnosis is difficult. As such, a systematic approach with the integration of clinical, biochemical, radiological, endoscopic, histological, and other laboratory tests is the key to reaching a diagnosis. In this article, we review the causes of ICT and present a clinical approach for the management of ICT. Causes of ICTThe ileocecal area could be involved by a variety of conditions, including benign or malignant tumors, infections, inflammatory conditions, ischemia, etc. However, ICT can also be a spurious finding, without any underlying cause. In various studies on bowel wall thickening, a normal ileocolonoscopy has been found

Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes

“…These GID-associated morphological changes could be detected by various imaging modalities. Abdominal CT is a readily accessible and highly efficient imaging modality for detecting morphological changes in the gastrointestinal tract[ 14 - 16 , 19 , 20 ]. In this study, we explored the abdominal imaging presentations in patients with SAA in search of the inflammatory niche when the patients presented with systemic inflammatory stresses.…”

“…In the evaluation of abdominal CT imaging abnormalities, particular attention has been given to inflammatory abnormalities in the ileocecal region and the colonic segments because they host the most enriched microbial community and lymphoid tissues[ 9 , 10 , 19 ]; therefore, inflammatory diseases and compromised intestinal barriers in these bowel segments have the most potent capacity to provide sufficient intestine-derived antigens and activated immune cells to affect hematopoietic and immune functions irrespective of whether they are primary damage or secondary to dysbiotic gut microbiota. As demonstrated by this study, all patients with SAA during flared inflammatory episodes had evident morphological abnormalities that could reflect the presence of a severely damaged intestinal structure and function in the ileocecal region and the colonic segments.…”

Two Cases of Endometriosis in the Cecum Detected by Contrast-enhanced Computed Tomography with Air/Carbon Dioxide Insufflation

“…In addition, the ileocecal region comprises the cecum, appendix, ileocecal valve, and the terminal ileum. It is occasionally difficult to identify neoplastic lesions because of the complex structure of this region ( 13 ). Feces in the intestinal lumen and compaction of the intestines with peristalsis may also hamper the identification of mass lesions in the ileocecal area.…”

The role of multidetector computed tomography enterography in the evaluation of localized malignant small intestinal lesions: retrospective radiological and pathological experience

“…Unfortunately, because of the absent or non-specific symptoms, they are usually diagnosed late or in their locally advanced stages [ 1 ]. The most frequent malignant small intestinal tumours are intestinal adenocarcinoma, neuroendocrinal tumours, lymphomas, and gastrointestinal stromal tumours (GIST) [ 2 ].…”