OBJECTIVE:Bacterial agents have been implicated in the early recurrence of Crohn's disease after ileocolectomy. The aim of our study was to identify and quantify bacteria associated with the ileal mucosa in patients and controls and to correlate specific bacteria with recurrence.METHODS:The predominant bacterial microflora of the ileum were enumerated and identified, aerobically and anaerobically, in biopsies obtained at the time of surgery or by endoscopy from 61 patients with Crohn's disease and 10 ileocolectomy controls. The 61 specimens were comprised of 13 ileal biopsies taken from resection specimens, seven taken after ileostomy, and 41 taken after ileocolectomy.RESULTS:Ileocolectomy induced a significant increase in bacterial counts and variety in the neoterminal ileum in both patients and controls that was not observed in ileostomy biopsies. Comparison between patients and controls revealed greater numbers of Escherichia coli and enterococci in Crohn's disease and of bifidobacteria and ruminococci in controls. Early recurrence was associated with high counts of E. coli and bacteroides and the frequent isolation of fusobacteria.CONCLUSION:After ileocolectomy, colonization of the neoterminal ileum is increased. Our data suggest that increases in the populations of specific bacteria such as E. coli, enterococci, bacteroides, and fusobacteria may be important in postoperative recurrence of Crohn's disease.

OBJECTIVE, Our aim was to compare the results of gadolinium-enhanced breath-hold MR angiography with those of conventional angiography for the study of mesenteric circulation.SUBJECTS AND METHODS. MR angiography and digital subtraction angiography were prospectively performed in 33 patients referred for hepatic, pancreatic, or mesenteric disease. MR angiography was performed with four three-dimensional acquisitions at 0, 30, 60, and 90 sec after injection of 0.1 mmol/kg of gadolinium. Selective conventional angiography was used as the standard of reference.RESULTS, A pure arterial angiogram (one on which veins could not be visualized) was obtained in 27 patients during the second or third acquisition. By subtracting the arterial phase from an arteriovenous phase (third or fourth acquisition) we obtained a pure venous angiogram (one on which arteries could not be visualized) in 28 patients. Agreement was good or excellent for the hepatic artery (kappa = 0.78), the superior mesenteric artery (kappa = 0.65), the splenic artery (kappa = 0.70), the portal vein (kappa = 1.0), the superior mesenteric vein (kappa = 0.88), and the splenic vein (kappa = 0.75). Agreement was poor, and vessels were better shown by conventional angiography, for the intrahepatic arteries (kappa = 0.006) and the branches of the superior mesenteric artery (kappa = 0.14). MR angiography and conventional angiography revealed 29 and 27 portosystemic collaterals, respectively.CONCLUSION. Dynamic breath-hold contrast-enhanced MR angiography compared favorably with conventional angiography in preoperative assessment of the proximal mesenteric arteries and in the evaluation of portal hypertension; however, conventional angiography is still necessary to evaluate distal arteries.

We describe a case of small bowel obstruction secondary to cholesterol crystal embolism in a 83-year-old man. Clinical symptoms were dominated by weight loss and vomiting. Small bowel baryum X-ray displayed a short and unique stricture of the jejunum. Atheromatous embolism was suspected in the presence of an aortic anevrysm. At laparotomy, a 2 cm stricture of jejunum was identified and a 6 cm length segment of small bowel was resected. Pathological Features were consistent with cholesterol crystal embolism. The patient did well 3 months after surgery. This observation points out the nonspecific clinical presentation of gastrointestinal cholesterol embolism.

We describe a case of small bowel obstruction secondary to cholesterol crystal embolism in a 83-year-old man. Clinical symptoms were dominated by weight loss and vomiting. Small bowel barrium X-ray displayed a short and unique stricture of the jejunum. Atheromatous embolism was suspected in the presence of an aortic aneurysm. At laparotomy, a 2 cm stricture of jejunum was identified and a 6 cm length segment of small bowel was resected. Pathological features were consistent with cholesterol crystal embolism. The patient did well 3 months after surgery. This observation points out the nonspecific clinical presentation of gastrointestinal cholesterol embolism.

BACKGROUND & AIMS:Infectious agents are suspected of being involved in the pathogenesis of Crohn's disease. This study was designed to look for the presence of virulent Escherichia coli strains associated with the ileal mucosa of patients with Crohn's disease.METHODS:E. coli strains were recovered from resected chronic ileal lesions (n = 20), neoterminal ileum after surgery from patients with (n = 19) and without (n = 11) endoscopic recurrence, and controls (n = 13). Bacterial adhesion was determined in vitro using intestinal cell lines; other associated virulence factors were assessed by DNA hybridization and polymerase chain reaction experiments.RESULTS:None of the strains harbored any of the virulence factor-encoding genes of E. coli involved in acute enteric diseases. However, mannose-resistant adhesion to differentiated Caco-2 cells was found for 84.6% and 78.9% of the E. coli strains isolated from chronic and early recurrent lesions, respectively, compared with 33% of controls (P < 0.02). In addition, 21.8% of the strains induced a cytolytic effect by synthesis of an alpha-hemolysin.CONCLUSIONS:E. coli strains isolated from the ileal mucosa of patients with Crohn's disease adhere to differentiated intestinal cells and may disrupt the intestinal barrier by synthesizing an alpha-hemolysin.

We report here a case of unexplained chronic pancreatitis diagnosed 4 years before the onset of ulcerative colitis. The diagnosis of chronic pancreatitis was confirmed by recurrent pancreatitis and irregularities of the main pancreatic duct on retrograde pancreatography. None of the the classical etiologies for chronic pancreatitis was found. Chronic pancreatitis associated with ulcerative colitis has already been reported in 5 cases. Our case reinforces the hypothesis of a non fortuitous association between both diseases.

We reported here a case of unexplained chronic pancreatitis diagnosed 4 years before the onset of ulcerative colitis. The diagnosis of chronic pancreatitis was confirmed by recurrent pancreatitis and irregularities of the main pancreatic duct on retrograde pancreatography. None of the classical etiologies for chronic pancreatitis was found. Chronic pancreatitis associated with ulcerative colitis has already been reported in 5 cases. Our case reinforces the hypothesis of a non fortuitous association between both diseases.