Presentation
Born in Indian subcontinent, TB prevalent country. Multiple overseas jobs. Previous ileocecal surgery. New onset weight loss and anorexia.
Patient Data
Unusually high and atypical orientation of the ileocecal junction ( post operative neo-terminal ileum).
Tight short segment stricture of the neo-terminal ileum with loop separation. Non shouldered edges of the stricture.
Thickening of the neo terminal ileum with marked surrounding inflammatory change.
Thick walled enhancing abscess in the right psoas/iliopsoas and right erector spinae muscles.
Small right retroperitoneal collection.
Case Discussion
The chief two diagnoses for ileocecal pathology is Crohns disease and TB.
Both can cause similar appearances on CT. A high level of suspicious is required in TB endemic regions.
Endoscopic and ideally histological or laboratory confirmation is desirable before the commencement of two very different types of treatment.
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