Abstract

*S. Driouiche, M. Lahlali, A. Lamine, H. Abid, A. Elmekkoui, M. ELyoussfi, D. Benajah, M. ELabkari, A. Ibrahimi and N. Lahmidani

ABSTRACT

Introduction: Terminal ileitis is a crossroads of several etiologies. the diagnostic orientation is essentially based on the clinical context supported by the endoscopic and histological aspect. the improvement of knowledge and the development of techniques for exploring the intestine have allowed the description of a large number of pathologies that can cause isolated ileal or right ileocolonic damage. Methodology: we retrospectively analyzed the records of patients with ileal involvement during the study period which runs from January 2016 to April 2019; collecting 59 cases of ileal disease associated or not with colonic disease and the clinical, endoscopic, histological characteristics as well as the etiological profile. Results: The sex ratio W/M was 1.2, the average age was 38 years (from 17 to 75 years). In the history: a history of Crohn's disease in 16 cases (27%), hemorrhagic rectocolitis in 7 cases (11.86%), ankylosing spondylitis in 4 cases (6.8), chronic anemia in 2 cases (3.4%), taking non-steroidal anti-inflammatory drugs in 1 case (2%), The clinical presentation of the ileal attack was: chronic diarrhea in 17 cases (29%) which is the most frequent reason for consultation, associated with abdominal pain in 15 cases (25%) followed by Koenig's syndrome in 12 cases (20%), among 59 cases; 17% were admitted in a table of complication, fortuitous discovery of ileitis in 3 cases (5%) and constipation in 2 cases (4%). Total ileocolonoscopy had objectified: Isolated ileal involvement in 4 cases (7%), ileocolonic involvement in 53 cases (90%) and extensive colonic involvement in 2 cases (3.4%) with an ulcerated appearance in 40 cases (67.8%), a stenosing appearance in 15 cases (25%) and a pseudo-tumor in 1 case (2%). All patients underwent a biopsy. Based on clinical, biological, endoscopic and histological criteria: the main etiologies were: Crohn's disease in 48 cases (81.35%), ileocecal tuberculosis in 3 cases (5.1%), reflux ileitis in 2 cases (3.4%), taking NSAIDs in 2 cases (3.4 %), undetermined ileitis in 2 cases (3.3%), lymphoma in 1 case (1.7%), Peutz jeghers syndrome in 1 case (1.7%). Conclusion: Our study shows that isolated ileal involvement represents 6.8% and ileocolonic in 89.83%. Crohn's disease remains the most frequent cause followed by ileocecal tuberculosis in our country.