Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country.

Objective: Clinical significance of ileocecal thickening on computed tomography (CT) is uncertain. We conducted this prospective study to determine the clinical relevance of ileal and/or cecal thickening on CT.

Methods: All patients with ileocecal thickening on CT were prospectively evaluated with ileocolonoscopy, biopsy, and other relevant investigations.

Results: Fifty patients (29 males, mean age 36.8 ± 13.21 years) were studied. Thirty nine (78%) patients presented with abdominal pain. On CT, 46 (92%) had a thickened wall of terminal ileum, 25 (50%) cecum, and 21 (42%) of both cecum and ileum. The mean wall thickness of ileum and cecum on CT was 7.23 + 3.2 mm and 5.5 + 3.1 mm, respectively. Final diagnosis was tuberculosis in 24 (48%) patients, Crohn's disease (CD) in 10 (20%), and adenocarcinoma in 1 patient. Colonoscopy demonstrated abnormal findings in 41 patients (82% patients with mucosal ulcerations being most common (n = 20 (40%). Of 15 (30%) patients with ileocecal bowel wall thickening, 4 (8%) patients had normal colonoscopy and histopathology (incidental ileocecal wall thickening), and in the remaining 11 patients, histopathology showed non-specific findings and these patients were asymptomatic without any specific treatment on last follow up ranging from 3 to 24 months. Involvement of cecum with ileocecal junction, ascending colon involvement, peri-ileocecal stranding, and long-segment stricture was significantly more common in patients with underlying disease as compared to nondiseased patients (P < 0.05).

Conclusions: A majority of patients with ileocecal wall thickening on CT have an underlying disease and should be further investigated by ileocolonoscopy and biopsy.