32 Coned Cecum

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 32-1 Amebiasis. (A) The small, shallow ulcers produce an irregular bowel margin and finely granular mucosa. The terminal ileum is not involved. (B) After a course of antiamebic therapy, the cecum returns to a normal appearance.

• Fig GI 32-2 Crohn's disease. In addition to rigid narrowing of the cecum (black arrows), there is incomplete filling of the terminal ileum (string sign; white arrows).

• Fig GI 32-3 Tuberculosis. The cecum is fibrotic and contracted, the ileocecal valve is irregular, gaping, and incompetent, and the terminal ileum appears to empty directly into the ascending colon (Stierlin's sign). Note the diffuse ulcerations in the ascending colon and the lymphoid follicles in the terminal ileum.39

• Fig GI 32-4 Ulcerative colitis. Concentric narrowing of the cecum with a gaping ileocecal valve.

• Fig GI 32-5 Carcinoma of the cecum. Severe narrowing and rigidity (arrows) give the radiographic appearance of a coned cecum. Note the extension of the process to involve the terminal ileum.

• Fig GI 32-6 Cecal diverticulitis. Deformity and contraction of the cecum on a barium enema examination performed approximately 3 weeks after the onset of symptoms in a 27-year-old man. Several diverticula (arrows) are seen along the lateral wall of the cecum (C).40

• Fig GI 32-7 Anisakiasis. Severe inflammatory changes in the cecum, ascending colon, and ileocecal valve in a patient who developed severe abdominal pain after eating raw fish.

• Fig GI 32-8 Typhoid fever. Nodularity and irregularity of the terminal ileum with deformity of the cecum. There was a rapid return to a normal appearance after appropriate therapy.41

• Fig GI 32-9 Yersinia enterocolitis. Conical narrowing and irregular margins of the cecum are present with mild inflammatory changes in the terminal ileum.