Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(1) > 1043475

Korean J Pediatr Gastroenterol Nutr. 2010 Mar;13(1):30-35. Korean.
Published online March 31, 2010.  https://doi.org/10.5223/kjpgn.2010.13.1.30
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Clinical Features of Infectious Ileocecitis in Children
Tae Ho Lee, M.D., Yoo Rha Hong, M.D.,* Gyu Min Yeon, M.D., Jun Woo Lee, M.D., and Jae Hong Park, M.D.
Department of Pediatrics, School of Medicine, Pusan National University, Busan, Korea.
*Department of Pediatrics, School of Medicine, Kosin University, Busan, Korea.
Department of Radiology, School of Medicine, Pusan National University, Busan, Korea.

Responsible author (Email: jhongpark@pusan.ac.kr )
Received February 16, 2010; Accepted March 08, 2010.

Abstract

Purpose

Infectious ileocecitis is an infection confined to the ileocecal area and one of the most common causes of pediatric abdominal pain. This study was performed to demonstrate the clinical features of infectious ileocecitis in children.

Methods

The medical records and radiologic findings of 37 patients with ileocecitis diagnosed by ultrasonography and/or computed tomography, who were admitted to Pusan National University Hospital from January 2004 and July 2008, were reviewed retrospectively. Viral gastroenteritis and secondary ileocecitis were excluded.

Results

The mean age of the patients was 4.8±3.4 years. One-half of the patients were preschool children. The chief complaint was abdominal pain (75.7%), diarrhea (10.8%), and vomiting (8.1%). Accompanying symptoms were fever (56.8%), vomiting (21.6%), and diarrhea (16.2%). The mean duration of abdominal pain, fever, diarrhea, and vomiting was 3.8±2.1, 3.0±1.9, 3.4±1.9, and 2.4±2.3 days, respectively. The frequency of diarrhea and vomiting was 5.8±2.2 and 4.0±2.8 per day, respectively. Diagnosis was made by abdominal ultrasonography in 22 patients (59.5%), abdominal CT in 2 patients (5.4%), and both modalities in 13 patients (35.1%). Besides the radiologic finding of thickening of the bowel wall, mesenteric lymphadenitis (59.5%), ascites (5.4%), and both mesenteric lymphadenitis and ascites (16.2%) were revealed. The mean duration of illness was 7.5±5.0 days. There were no specific laboratory findings, and culture studies with stool or blood were negative. All of the patients recovered completely without specific treatment.

Conclusion

Infectious ileocecitis has acute appendicitis-mimicking symptoms, but is self-limited within a few days, thus unnecessary treatment and work-up is avoided. However, distinguishing infectious ileocecitis from appendicitis, inflammatory bowel disease, and mesenteric lymphadenitis is important.

Keywords: Infectious ileocecitis; Children

Figures


Fig. 1
Ultrasound imaging of ileocecitis. US scan shows thickening of the wall of the terminal ileum (short arrow) and cecum (long arrow). Image is obtained with a linear transducer in the right lower quadrant.
Click for larger image

Tables


Table 1
Age and Gender Distribution
Click for larger image


Table 2
Chief Complaints
Click for larger image


Table 3
Accompanying Symptoms
Click for larger image


Table 4
Duration of Symptoms
Click for larger image


Table 5
Initial Impression
Click for larger image

References
1. Puylaert JB. Ultrasonography of the acute abdomen: gastrointestinal conditions. Radiol Clin North Am 2003;41:1227–1242.
2. Puylaert JB, Van der Zant FM, Mutsaers JA. Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings. Eur Radiol 1997;7:3–9.
3. Zganjer M, Roic G, Cizmic A, Pajic A. Infectious ileocecitis-appendicitis mimicking syndrome. Bratisl Lek Listy 2005;106:201–202.
4. Bass D, Cordoba E, Dekker C, Schuind A, Cassady C. Intestinal imaging of children with acute rotavirus gastroenteritis. J Pediatr Gastroenterol Nutr 2004;39:270–274.
5. Puylaert JB. Mesenteric adenitis and acute terminal ileitis: US evaluation using graded compression. Radiology 1986;161:691–695.
6. Tarr PI, Weinberger E, Hatch EI Jr, Christie DL. Bacterial ileocecitis caused by Escherichia coli O157:H7. J Pediatr Gastroenterol Nutr 1992;14:261–263.
7. Puylaert JB, Vermeijden RJ, van der Werf SD, Doornbos L, Koumans RK. Incidence and sonographic diagnosis of bacterial ileocaecitis masquerading as appendicitis. Lancet 1989;2:84–86.
8. Van Noyen R, Selderslaghs R, Bekaert J, Wauters G, Vandepitte J. Bacterial ileocaecitis and appendicitis. Lancet 1990;336:518.
9. Puylaert JB, Bodewes HW, Vermeijden RJ, Vlaspolder F, Doornbos L, Koumans RK, et al. Bacterial ileocecitis, a "new" disease. Ned Tijdschr Geneeskd 1991;135:2176–2180.
10. Seelen JL, Puylaert JB. Bacterial ileocecitis: a "new" disease. Ultraschall Med 1991;12:269–271.
11. Saebo A, Lassen J. Acute and chronic gastrointestinal manifestations associated with Yersinia enterocolitica infection. Ann Surg 1992;215:250–255.
12. Kim TK, Kim KH, Sohn DK, Kim AJ, Kim HY. Sonography of the pediatric acute abdomen in the emergency center. J Korean Soc Emerg Med 2003;14:610–614.
13. Park CH, Lee DH, Kim HL, Park JM, Hwang JB, Kim HS, et al. Clinical observation of mesenteric lymphadenitis in children. Korean J Pediatr 2004;47:31–35.