SALMONELLA-INDUCED AND SHIGELLA-INDUCED ILEITIS - CT FINDINGS IN 4 PATIENTS

Purpose: The purpose of this study is to describe and illustrate the C T appearance of four cases of acute terminal ileitis induced by nontyp hoidal Salmonella and Shigella infection and to review the radiographi c and endoscopic findings of these entities. Method: The medical recor ds, CT examinations, and small bowel examinations of three patients wi th Salmonella ileitis and one patient with Shigella ileitis were retro spectively reviewed. CT examinations were done in four patients, colon oscopy in three patients, and small bowel examinations in two patients . Stool cultures established the diagnosis of nontyphoidal Salmonella enteritis in three patients and Shigella enteritis in one patient. The patients' symptoms and clinical findings resolved promptly following supportive therapy and appropriate antibiotic therapy. Results: CT sho wed slight circumferential and homogeneous thickening of the terminal ileum over a segment of 10-15 cm in patients with Salmonella ileitis. Associated mild thickening of the wall of the colon was present in add ition. Small bowel examination performed in one patient revealed a spa stic terminal ileum with thickened mucosal folds. Colonoscopy revealed acute coli tis involving the colon diffusely in one case, but sparing the distal 50 cm of the colon in one case. CT showed more pronounced thickening of the terminal ileum and a target configuration in the pat ient with Shigella ileitis. Small bowel examination revealed narrowing , irregular contour, several large nodular defects (thumbprinting), an d a severely ulcerated mucosa affecting the terminal ileum. Colonoscop y revealed a normal colon and large ulcerations with fibro-purulent ex udate in the terminal ileum. Conclusion: In patients with severe Salmo nella or Shigella infections or persistent and/or confusing clinical p resentations, CT can play a complementary but important role in the in itial diagnostic evaluation. It avoids clinical mismanagement, circumv ents unnecessary invasive procedures, and contributes to the efficient workup and therapy in this group of individuals.