Idiopathic chronic ulcerative enteritis with perforation and recurrent bleeding: A case report

Abstract

Idiopathic chronic ulcerative enteritis (ICUE) is a distinct entity without a defined etiology and is rarely seen in the clinic. Patients with ICUE mainly present with insidious abdominal symptoms such as chronic abdominal pain and intermittent gastrointestinal hemorrhage and symptoms of malnourishment in the early stages of the disease. ICUE is always difficult to diagnose. However, as the disease progresses, patients have a variety of acute abdominal complications such as hemorrhage, perforation, or ileus. Surgical intervention is always needed, and the condition can recur and require repeat laparotomy. When diffuse ulceration of the small bowel is present in the absence of recognizable causes, it is classified as nonspecific or idiopathic. The histological examination always demonstrates an acute, chronic inflammatory infiltration without giant cells, granulomas, or villous atrophy. The etiology of ICUE has not been identified, and its pathogenesis is poorly understood; therefore, radical surgical resection is considered the best available treatment. Here, we report a case of ICUE characterized by nonspecific, multiple, small intestinal ulcers resulting in perforation and recurrent bleeding. The differential diagnosis and the treatment are also discussed.

Keywords: Idiopathic ulcerative enteritis; Small intestinal ulcer; Perforation; Gastrointestinal hemorrhage; Bleeding.

Core tip: This is a case report of idiopathic chronic ulcerative enteritis (ICUE) with perforation and recurrent bleeding. Complete clinical material of the patient is presented in this case report. We also provide several images, including colonoscopy, radiography, computed tomography, and pathology. All of this material reflected the clinical characteristics of ICUE. When patients present with multiple, nonspecific, small intestinal ulcers without a defined etiology, a diagnosis of ICUE should be considered. This case report will help diagnose and treat patients with similar clinical symptoms.