Alimentary TractEarly lesions of recurrent Crohn's disease caused by infusion of intestinal contents in excluded ileum☆
Section snippets
Materials and methods
Three patients, 29, 38, and 51 years old, underwent a resection of the diseased terminal ileum with ileocolonic anastomosis and a temporary diverting “loop-ileostomy” constructed proximally to the anastomosis.4 The indication for diversion of the fecal stream was perforation and severe anal disease in 1 patient, ileal disease with fistulization to the rectosigmoid colon and sacral bone in the second patient, and perforation of a previously constructed ileocolonic anastomosis in the third
Results
The endoscopic appearance of the neoterminal ileum was normal before as well as after challenge with ileal fluid, although minor sequelae of biopsy removal were observed at day 8. All ileal biopsy specimens from the distal loop of the neoterminal ileum were entirely normal before reinfusion in the 3 patients with Crohn's disease. None of them experienced any symptoms during this week. After reinfusion, a moderate to severe increase of mononuclear cells and eosinophils in the lamina propria and
Discussion
Inflammatory cells in Crohn's disease enter the mucosal compartment via transendothelial migration promoted by adhesion molecules. Monocytes, T cells, and neutrophils all contribute to the formation of an inflammatory infiltrate. The majority of mononuclear cells infiltrating the inflamed mucosa has been recruited recently from the circulation.12 In the present study on the effects of infusion of intestinal contents into the excluded ileum and ileocolonic anastomosis, we show that inflammatory
References (28)
- et al.
Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection
Gastroenterology
(1995) - et al.
Effect of fecal stream diversion on recurrence of Crohn's disease in the neoterminal ileum
Lancet
(1991) - et al.
Expression of leukocyte adhesion molecules by mucosal mononuclear phagocytes in inflammatory bowel disease
Gastroenterology
(1991) - et al.
Early mucosal changes in Crohn's disease
Gut
(1993) - et al.
Ileostomy without colectomy
- et al.
A human macrophage-associated antigen (CD68) detected by six different monoclonal antibodies
Br J Haematol
(1989) - et al.
The use of monoclonal antibodies in histopathological diagnosis
- et al.
Expression of HLA DR antigens by colonic epithelium in inflammatory bowel disease
Clin Exp Immunol
(1983) - et al.
Discrimination of human macrophages and dendritic cells by means of monoclonal antibodies
Scand J Immunol
(1986) - et al.
Functional characterization of a novel anti-B7-1 monoclonal antibody
Eur J Immunol
(1992)
Lymphocyte function–associated antigen-1 (LFA-1) interaction with intercellular adhesion molecule-1 (ICAM-1) is one of at least three mechanisms for lymphocyte adhesion to cultured endothelial cells
J Cell Biol
Adhesion receptors of the immune system
Nature
Origin and turnover of monocytes and macrophages
Curr Top Pathol
Myeloid section report
Cited by (0)
- ☆
Address requests for reprints to: Geert R. D'Haens, M.D., Ph.D., Department of Internal Medicine, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Fax: (32) 16-34-4299.