Distribution
Discontinuous pattern of inflammation
Skip lesions
Ulcerous lesion
Longitudinal ulcer (mesenteric side)
Fissuring ulcer
Round ulcer (longitudinal arrangement)
Aphthous ulcer (longitudinal arrangement)
Elevated lesion
Cobblestone appearance
Inflammatory polyp
Deformity
Asymmetrical deformity
Pseudodiverticular formation
Others
Stricture
Fistula
Table 6.2
Major differential diagnosis (small bowel disorders) of Crohn’s disease
Category | Cause | Disease |
|---|---|---|
Acute infectious enteritis | Bacterial | Vibrio enteritis |
Salmonella enteritis | ||
Campylobacter enteritis | ||
Yersinia enteritis | ||
Viral | Cytomegalovirus enteritis | |
Parasitic | Anisakiasis | |
Chronic infectious enteritis | Bacterial | Intestinal tuberculosis |
Parasitic | Giardiasis | |
Strongyloidiasis | ||
Isosporiasis | ||
Acute noninfectious enteritis | Inflammatory | Eosinophilic gastroenteritis |
Henoch-Schönlein purpura | ||
Vascular | Ischemic enteritis | |
Chronic noninfectious enteritis | Inflammatory | Behçet’s disease |
Radiation enteritis | ||
Chronic nonspecific multiple ulcers of the small intestine | ||
Toxic | NSAID-induced enteritis | |
Others | Amyloidosis | |
Benign lymphoid hyperplasia |
6.2 Small Bowel Enteroscopy
6.2.1 Normal Findings
Figure 6.1.
Fig. 6.1
Normal findings of the small intestine (a) Normal jejunal mucosa. The Kerckring’s folds are prominent. (b) Normal ileal mucosa. The folds in the ileum are less prominent and villi are rather flattened compared to the jejunum. (c) Normal ileal vessels (white light). (d) Normal ileal vessels are observed by FUJI Intelligent Color Enhancement (FICE). (e, f) Normal ileal villi are observed by magnifying view (e white light, f after dye spraying)
6.2.2 Various Findings of Inflammation
6.2.2.1 Aphthous Ulcer, Small Ulcer
Aphthous ulcer is the small and shallow ulcerous lesion of the intestine. Although aphthous ulcers are often observed in various inflammatory small bowel disorders, these are not specific findings. However, certain characteristics of aphthous ulcers, such as their arrangement and distribution, might be useful in diagnosing each disease (Fig. 6.2, 6.3, 6.4, and 6.5).
Fig. 6.2
Crohn’s disease (the lower ileum, retrograde approach of DBE). (a) Multiple aphthous ulcers are arranged in a longitudinal direction. Typical small lesions of Crohn’s disease (CD) show longitudinal arrangement. (b) The aphthous ulcers are relatively large and scattered densely in the ileal lumen. These types of aphthous ulcers are more likely to progress to the typical longitudinal ulcer (Reprinted b with permission from Hirai et al. [21]. Copyright 2009 by IGAKU-SHOIN Ltd)
Fig. 6.3
NSAID-induced small bowel lesions (the mid ileum, retrograde approach). NSAID-induced small bowel lesions tend to show the circumferential arrangement. (a, b) Multiple aphthous ulcers are arranged in a transverse direction (a white light, b after dye spraying)
Fig. 6.4
Chronic nonspecific multiple ulcers of the small intestine (the lower ileum, retrograde approach). Chronic nonspecific multiple ulcers of the small intestine (CMUSI) are rare entity which manifest the chronic clinical course of iron deficiency anemia and hypoproteinemia resulting from occult blood loss from multiple ulcers of the small intestine. Small bowel lesions of CMUSI are usually located in the lower ileum without involving the terminal ileum and show various types of ulcers including aphthous ulcers. (a) A few small red aphthous ulcers are observed close to the ileal stricture. (b) An aphthous ulcer is seen close to the main shallow lineal ulcer with partial stenosis. Small lesions of CMUSI are usually located near the main lesions (Reprinted b with permission from Hirai et al. [21] Copyright 2009 by IGAKU-SHOIN Ltd)
Fig. 6.5
Intestinal tuberculosis (the terminal ileum, retrograde approach). The small lesions of intestinal tuberculosis are typically seen in a Peyer’s patch. These small ulcerous lesions usually tend to spread in a transverse or circumferential orientation relative to the long axis of the intestinal lumen. (a, b) Multiple aphthous ulcers are seen in a Peyer’s patch (arrows) of the terminal ileum (a white light, b after dye spraying)
6.2.2.2 Ulcer, Ulcerous Lesion
Ulcer is the most popular lesion of small bowel inflammatory disorders. Various shapes, sizes, depths, and arrangement patterns of small bowel ulcers can be observed by BAE. These characteristics of ulcers are useful for the diagnosis of each disease (Fig. 6.6, 6.7, 6.8, 6.9, 6.10, 6.11, 6.12, and 6.13).
Fig. 6.6
Crohn’s disease (the lower ileum, retrograde approach). (a, b) A typical longitudinal ulcer is seen in the mesenteric side of the ileal lumen (a white light, b after dye spraying). (c, d) Cobblestone appearance with longitudinal ulcers is seen in the ileum
Fig. 6.7
NSAID-induced small bowel lesions (the mid jejunum, antegrade approach). Typical ulcers of NSAID-induced small bowel lesions are usually seen arranged circumferentially along the Kerckring’s fold. (a, b) A narrow circumferential ulcer along the Kerckring’s fold is seen in the jejunum (Reprinted b with permission from Hirai et al. [22]. Copyright 2007 by TOKYO IGAKUSHA LTD)
Fig. 6.8
Intestinal tuberculosis (the mid ileum, retrograde approach). (a, b) Geographically shaped ulcer is seen in a Peyer’s patch in the lower ileum (a white light, b after dye spraying). (c, d) Irregularly shaped ulcers with exudate in the antimesenteric side of the ileal lumen (a white light, b after dye spraying)
Fig. 6.9
Chronic nonspecific multiple ulcers of the small intestine (the lower ileum, retrograde approach). (a) A thin and linear ulcer is seen in a diagonal orientation relative to the long axis of the ileal lumen. (b) An ulcer with clear shape and margin in the lower ileum
Fig. 6.10
Intestinal Behçet’s disease (the terminal ileum, retrograde approach). (a, b) A sharply demarcated deep ulcer in the terminal ileum (a white light, b after dye spraying)
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