.
MICROSCOPIC FEATURES
Most common finding in the early phase
is a marked oedema of the
affected bowel wall, most marked in
the submucosa.
*
There is dilatation of lymphatics
and hyperemia, increase in
the proportion of goblet cells.
*
There is a fibrinopurulent exudate on the serosal surface.
*
In the later phase of the
disease, fibrosis of submucosa and
subserosa is seen with focal ulcers that rarely penetrate the
muscularis musocae infiltrations
with lymphocytes, plasma
cells
and oesonophils
*
Fibrosis is accompanied by diffuse infiltration of mononuclear
cells and hyperplasia of lymphoid
follicles.
*
The muscularis also demonstrates
hypertromphy, fibrosis and
cellular infiltrate
*
Granulomas may be present in submucosa, subserosa or regional
lymphnodes, these do not caseate.
Mucosa is denuded over wide
area interspersed with mucosal islands.
*
The villi are blunted and glands
atrophied in these mucosal
islands.
CLINICAL FEATURES
Some
patients present with a fibrile illness
without abdominal
symptoms or signs
Careful questioning
usually elicits a
history of abdominal
discomfort that increases after eating, mild anorexia
and loose
stools.
In
about 10% of patients mostly
young, the onset is acute and
mimics acute appendicits.
There is midabdominal or right lower
qudarant pain and tenderness
accompanied by low grade fever and
*
Leucocytosis
*
vomiting
*
And occasionally Diarrhoea
*
In majority of patients onset is insidious, protracted
and
slowly progressive
*
Symptomatic periods are interspered with symptom free periods
*
Pain or abdominal discomfort is the most frequent symptom, it
is intermittent and precipated by dietary indiscretion
Gradually these complaints take on the characteristics
of frank
partial obstruction with distension
and visible bowel loops.
Second type of presentation is a
constant ache in in the abdomen.
There is tenderness and a palpable
mass.
*
Diarrhoea is a frequent symptom and is present in about 85% of
patients.
*
Fever is present in about one-third patients, moderate weight
loss and easy fatiguability.
Systemic manifestations such
as polyarthritis, pyoderma
gangrenosum and opthalmic
complications are rare.
INVESTIGATIONS
Barium enema with ileocecal reflux
demonstrate involvement of the
terminal ileum,
a thin stream of barium is seen
producing the
string sign of Kantor.
Thickening of the wall and mesentery
increases the space between
