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

doi:10.4166/kjg.2010.56.6.382

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Kim, Kim, Ok, Ryu, Lee, Moon, Lee, and Lee: Chronic Non-granulomatous Ulcerative Jejunoileitis Assessed by Wireless Capsule Endoscopy

Original Article

Korean J Gastroenterol 2010;56(6):382-386.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.6.382

Chronic Non-granulomatous Ulcerative Jejunoileitis Assessed by Wireless Capsule Endoscopy

Hyung Hun Kim, M.D., You Sun Kim, M.D., Kyung Sun Ok, M.D., Soo Hyung Ryu, M.D., Jung Hwan Lee, M.D., Jeong Seop Moon, M.D., Hyuck Sang Lee, M.D.^∗, Hye Kyung Lee, M.D.^†

Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

^∗Department of General Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

^†Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence to: You Sun Kim, M.D. Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 85, Jeo-dong 2-ga, Jung-gu, Seoul 100-032, Korea Tel: +82-2-2270-0012, Fax: +82-2-2270-0257 E-mail: yousunk69@korea.com

Received 13 January 2010 Accepted 18 May 2010

Abstract

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 re-mains 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. Wireless 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.

Keywords: Ileitis, Ulcerative, Hypoalbuminemia, Malabsorption syndromes, Capsule endoscopy

REFERENCES

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Fig. 1.

99m-Tc albumin scan finding. At 2 hours, increased ra-dioactivities at the left upper quadrant (arrowheads) were noticed.

Fig. 2.

Wireless capsule endoscopy findings. (A) It revealed multiple geographic and shallow ulcerations with villous atrophy on the distal jejunum. (B) It showed stenotic area, which caused capsule retention in the proximal ileum.

Fig. 3.

The gross findings of resected specimen. (A) It showed a dilated proximal bowel segment 4.2 cm in diameter. The mesenteric fat tissue was mildly adher-ent to the serosal surface focally. (B) On opening, several shallow transverse or oval ulcerations were observed with two white fi-brous stenotic foci.

Fig. 4.

Microscopic findings. (A) It showed non-granulomatous ulcers with focal villous atrophy (H&E, ×40). (B) A few cryptitis foci were observed (H&E, ×100).

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