Kim SH, Kim JW, Jeong JB, Lee KL, Kim BG, Choi YH. Differential diagnosis of Crohn's disease and intestinal tuberculosis in patients with spontaneous small-bowel perforation.
Dig Surg 2014;
31:151-6. [PMID:
24970687 DOI:
10.1159/000363066]
[Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/19/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIMS
Spontaneous small-bowel perforation caused by Crohn's disease (CD) or intestinal tuberculosis (ITB) is a rare disease entity. We investigated the clinical features and radiologic findings of patients with CD or ITB who presented with a spontaneous small-bowel perforation.
METHODS
Between January 2001 and December 2010, sixty-two patients underwent surgery due to a spontaneous small-bowel perforation, including 21 (33.9%) CD patients and 18 (29.0%) ITB patients. Clinical and radiologic features were compared between CD and ITB patients.
RESULTS
The mean age was significantly lower in CD patients than in ITB patients (p = 0.014). Diarrhea was more common in CD. By contrast, night sweating and a previous history of tuberculosis were more common in ITB. Only 27.8% of patients with ITB had a positive QuantiFERON-TB Gold test. CT findings such as bowel wall thickening of more than 10 mm, omental thickening, and intra-abdominal lymphadenopathy larger than 10 mm were more common among perforations caused by ITB. Mesenteric fat infiltration was a more frequent finding in CD than in ITB.
CONCLUSIONS
Clinical symptoms and radiologic findings may aid in the differential diagnosis between CD and ITB in patients presenting with spontaneous small-bowel perforation.
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