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What Does This CT Scan Showing Mild Thickening Of The Terminal Ileum Indicate?
Question: hi doctor
i have been sufferinf gfrom constipation bloating and severe stoamacha ches for sometime. had undergone uterus removal 10 yrs back. since then i have been facing this problem. i have done ct scan which saysthat there isa mild thickening of the the terminal ileum, ileocaecal junction and caecum seen. there is consequent mild dilatation of the proximal ileum loops. minimal fluid is seen in lower abdomen
i have been sufferinf gfrom constipation bloating and severe stoamacha ches for sometime. had undergone uterus removal 10 yrs back. since then i have been facing this problem. i have done ct scan which saysthat there isa mild thickening of the the terminal ileum, ileocaecal junction and caecum seen. there is consequent mild dilatation of the proximal ileum loops. minimal fluid is seen in lower abdomen
Brief Answer:
Possibility of Tuberculosis. Needs evaluation
Detailed Answer:
Hi.
Good Morning.
Thanks for your query and elucidate history.
Your symptoms are well coordinated with the finding on CT scan.
The report is so specific.
In XXXXXXX this is most suggestive of tuberculosis of abdomen unless proved otherwise.
I am sure your Doctor must have discussed this with you and advised further investigations to prove on the diagnosis.
I would suggest the following::
Blood- Complete Hemogram, ESR, Liver function tests including serum Proteins, . Kidney function tests, blood Sugar. Quantiferon Gold test for TB
Urine- Routine and microscopy
Stool- routine , microscopy, Staining for AFB.
X-ray Chest
Colonoscopy- and biopsy
Enteroscysis- (if the stricture is not tight) to see classical narrowing.
If need be- a Diagnostic Laparoscopy
In some cases anti-tubercular treatment is started on an''empirical basis, the clinical improvement is seen and if positive the treatment is continued.
With the proper treatment sometimes the surgery for removing the narrowing can be avoided and one gets alright with the proper treatment.
Also needed is proper protein and multi-vitamin supplements. Liquid diet.
I hope, you are already under a proper treatment...
Possibility of Tuberculosis. Needs evaluation
Detailed Answer:
Hi.
Good Morning.
Thanks for your query and elucidate history.
Your symptoms are well coordinated with the finding on CT scan.
The report is so specific.
In XXXXXXX this is most suggestive of tuberculosis of abdomen unless proved otherwise.
I am sure your Doctor must have discussed this with you and advised further investigations to prove on the diagnosis.
I would suggest the following::
Blood- Complete Hemogram, ESR, Liver function tests including serum Proteins, . Kidney function tests, blood Sugar. Quantiferon Gold test for TB
Urine- Routine and microscopy
Stool- routine , microscopy, Staining for AFB.
X-ray Chest
Colonoscopy- and biopsy
Enteroscysis- (if the stricture is not tight) to see classical narrowing.
If need be- a Diagnostic Laparoscopy
In some cases anti-tubercular treatment is started on an''empirical basis, the clinical improvement is seen and if positive the treatment is continued.
With the proper treatment sometimes the surgery for removing the narrowing can be avoided and one gets alright with the proper treatment.
Also needed is proper protein and multi-vitamin supplements. Liquid diet.
I hope, you are already under a proper treatment...
Above answer was peer-reviewed by :
Dr. Prasad
Thank you doctor for your prompt reply,
Yes we have performed colonscopy and biopsy,infact the colonoscopy was performed twice. first colonscopy revealed IC valve inflammed and narrowed.biopsy did not revelaed any mycobacterium tuberculosis , but did reveal non tuberculosis mycobacterium. we also performed barium enterocolysis, but its report was absolutely normal. she did undergo tb treament few yrs back.
my question was is she suffering from crohns disease or any other disease, we are performing laproscopy this week to get to the bottom the problem. she gets this terrible cramps suddenly if she eats fibrous food.will the laproscopy or open surgery (incase laproscopy does not give proper findings) will solve the problem. the doc says he is confident he can get to the root of it. but i wanted a second opinionon it
Yes we have performed colonscopy and biopsy,infact the colonoscopy was performed twice. first colonscopy revealed IC valve inflammed and narrowed.biopsy did not revelaed any mycobacterium tuberculosis , but did reveal non tuberculosis mycobacterium. we also performed barium enterocolysis, but its report was absolutely normal. she did undergo tb treament few yrs back.
my question was is she suffering from crohns disease or any other disease, we are performing laproscopy this week to get to the bottom the problem. she gets this terrible cramps suddenly if she eats fibrous food.will the laproscopy or open surgery (incase laproscopy does not give proper findings) will solve the problem. the doc says he is confident he can get to the root of it. but i wanted a second opinionon it
Brief Answer:
please go ahead with Laparoscopy / laparotomy
Detailed Answer:
Sorry for the late.
My comments are as follows:
1. Good that colonoscopy and enteroclysis was performed. They do give a good idea about the probable diagnosis. You mean to say enteroclysis did not show any narrowing or proximal dilatation.
Colonoscopic biopsy are small punch-biopsies and may not give full information every time.
2. I hope the ATT (Anti-tubercular treatment) was taken for a full course.
3. Crohn's: This is still not very common in XXXXXXX And is usually a colonoscopic diagnosis done by a Medical Gastroenterologist.
4. Yes, Laparoscopy is a very good tool to have a diagnosis and many times can be therapeutic too.
5. Cramps on fibrous foods can be due to borderline stricture at the terminal ileum and be missed as we do enteroclysis on ''preparation'' only. Ideally enteroclysis done without preparation can give a true clinico-pathological picture.
6. Yes, Laparoscopy and if needed open surgery will definitely help more. And if there is thickening / narrowing/ stricture, bypass surgery or right hemicolectomy will solve the problem and histo-pathology will give the perfect diagnosis too.
Please go ahead.
All the best wishes for early and complete recovery.
Please feel free to ask more if you need to.
please go ahead with Laparoscopy / laparotomy
Detailed Answer:
Sorry for the late.
My comments are as follows:
1. Good that colonoscopy and enteroclysis was performed. They do give a good idea about the probable diagnosis. You mean to say enteroclysis did not show any narrowing or proximal dilatation.
Colonoscopic biopsy are small punch-biopsies and may not give full information every time.
2. I hope the ATT (Anti-tubercular treatment) was taken for a full course.
3. Crohn's: This is still not very common in XXXXXXX And is usually a colonoscopic diagnosis done by a Medical Gastroenterologist.
4. Yes, Laparoscopy is a very good tool to have a diagnosis and many times can be therapeutic too.
5. Cramps on fibrous foods can be due to borderline stricture at the terminal ileum and be missed as we do enteroclysis on ''preparation'' only. Ideally enteroclysis done without preparation can give a true clinico-pathological picture.
6. Yes, Laparoscopy and if needed open surgery will definitely help more. And if there is thickening / narrowing/ stricture, bypass surgery or right hemicolectomy will solve the problem and histo-pathology will give the perfect diagnosis too.
Please go ahead.
All the best wishes for early and complete recovery.
Please feel free to ask more if you need to.
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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