Cryptogenic multifocal ulcerous stenosing enteritis

Radiologic features and clinical behavior

Jiyoung Hwang, Jin Sil Kim, Ah Young Kim, Joon Seok Lim, Se Hyung Kim, Min Ju Kim, Mi Sung Kim, Kyoung Doo Song, Ji Young Woo

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODS Twenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during followup period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTS The main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on followup SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSION Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.

Original languageEnglish
Pages (from-to)4615-4623
Number of pages9
JournalWorld Journal of Gastroenterology
Volume23
Issue number25
DOIs
Publication statusPublished - 2017 Jul 7

Fingerprint

Enteritis
Pathologic Constriction
Tomography
Recurrence
Abdominal Pain
Ulcer
Anemia
Magnetic Resonance Spectroscopy
Republic of Korea
Electronic Health Records
Jejunum
Ileum
Abscess
Small Intestine
Fistula
Gastrointestinal Tract
Mucous Membrane

Keywords

  • Computed tomography
  • Cryptogenic multifocal ulcerous stenosing enteritis
  • Diagnosis
  • Small bowel series
  • Small intestine

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Cryptogenic multifocal ulcerous stenosing enteritis : Radiologic features and clinical behavior. / Hwang, Jiyoung; Kim, Jin Sil; Kim, Ah Young; Lim, Joon Seok; Kim, Se Hyung; Kim, Min Ju; Kim, Mi Sung; Song, Kyoung Doo; Woo, Ji Young.

In: World Journal of Gastroenterology, Vol. 23, No. 25, 07.07.2017, p. 4615-4623.

Research output: Contribution to journalArticle

Hwang, J, Kim, JS, Kim, AY, Lim, JS, Kim, SH, Kim, MJ, Kim, MS, Song, KD & Woo, JY 2017, 'Cryptogenic multifocal ulcerous stenosing enteritis: Radiologic features and clinical behavior', World Journal of Gastroenterology, vol. 23, no. 25, pp. 4615-4623. https://doi.org/10.3748/wjg.v23.i25.4615
Hwang, Jiyoung ; Kim, Jin Sil ; Kim, Ah Young ; Lim, Joon Seok ; Kim, Se Hyung ; Kim, Min Ju ; Kim, Mi Sung ; Song, Kyoung Doo ; Woo, Ji Young. / Cryptogenic multifocal ulcerous stenosing enteritis : Radiologic features and clinical behavior. In: World Journal of Gastroenterology. 2017 ; Vol. 23, No. 25. pp. 4615-4623.
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abstract = "AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODS Twenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during followup period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTS The main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on followup SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSION Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.",
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N2 - AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODS Twenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during followup period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTS The main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on followup SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSION Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.

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