Regional Enteritis Involving the Duodenum

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REGIONAL enteritis is a disease with diverse and protean manifestations that may simulate those of many other gastrointestinal conditions. Although the terms “terminal ileitis” and “regional ileitis” have been used as synonyms for “regional enteritis,” they are misleading for the disease is not limited to the terminal ileum but may involve any segment of the small intestine and portions of the colon. The disease frequently involves the small intestine with “skip areas” of inflammation with normal intestinal mucosa between the involved segments. Comfort and associates1 have suggested that the condition be termed “nonspecific granulomatous gastroenteritis,” but this vague term merely emphasizes the fact that little has been added to our knowledge of regional enteritis since Crohn’s2 original description of its etiology and pathogenesis in 1932. “Regional enteritis” remains the most widely accepted name for this condition.

Regional enteritis involves the terminal ileum in 75 per cent of the cases. The frequency of involvement of a specific segment is directly related to its proximity to the ileocecal valve; however, isolated cases of enteritis occurring high in the jejunum have been reported. Involvement of the duodenum, a relatively short segment, is unusual; there are only 13 reports1,3–7 of such cases in the literature. Although some of the reported cases are not described histopathologically, all of them must be considered as nonspecific, granulomatous, cicatrizing inflammation of the uppermost intestinal tract (duodenum), because of the clinical characteristics and the surgical descriptions of the pathology.

Comfort1 reported a typical clinical picture presented by patients having . . .



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