Korean J Gastroenterol.  2010 Dec;56(6):382-386. 10.4166/kjg.2010.56.6.382.

Chronic Non-granulomatous Ulcerative Jejunoileitis Assessed by Wireless Capsule Endoscopy

• Kim HH
• Kim YS
• Ok KS
• Ryu SH
• Lee JH
• Moon JS
• Lee HS
• Lee HK

• KMID: 1775855
• DOI: http://doi.org/10.4166/kjg.2010.56.6.382

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 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. 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.

Keyword

Ileitis, Ulcerative; Hypoalbuminemia; Malabsorption syndromes; Capsule endoscopy

MeSH Terms

Abdominal Pain/etiology
Aged
Atrophy/diagnosis/etiology
Capsule Endoscopy
Chronic Disease
Diagnosis, Differential
Humans
Ileitis/*diagnosis/pathology
Intestine, Small/pathology
Jejunal Diseases/*diagnosis/pathology
Malabsorption Syndromes/diagnosis/pathology
Male
Mastectomy, Segmental
Protein-Losing Enteropathies/diagnosis
Technetium Tc 99m Aggregated Albumin/diagnostic use
Ulcer/pathology

Figure

• 

  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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