Blanco, Paola, MD

Hickey, Patrick, DO

Kreitman, Kyle, DO

Shah, Hiral N, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineThe Non-Healing lleocecal Ulcer.Kyle Kreitman DOLehigh Valley Health Network, Kyle.Kreitman@lvhn.orgPatrick Hickey DOLehigh Valley Health Network, Patrick.Hickey@lvhn.orgPaola Blanco MDLehigh Valley Health Network, Paola_G.Blanco@lvhn.orgHiral N. Shah MDLehigh Valley Health Network, hiral_n.shah@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Gastroenterology Commons, and the Internal Medicine CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKreitman, K. Hickey, P. Blanco, P. Shah, H. (2018, May). The Non-Healing lleocecal Ulcer. Poster Presented at: POMA ClinicalAssembly, King of Prussia, PA.© Lehigh Valley Health NetworkINTRODUCTIONBehcet’s disease is a rare vasculitic disorder characterized by  recurrent oral aphthous ulcers, genital ulcers, and uveitis. Terminal  ileocecal  involvement is seen in less than 50% of patients with symptoms including abdominal pain, diarrhea, and bleeding. Due to its infrequency, GI involvement can make it difficult to differentiate it from IBD, in particular Crohn’s. The Non-Healing Ileocecal Ulcer K. Kreitman, DO*, P. Hickey DO*, P. Blanco, MD**, H Shah, MD***Department of Medicine, Lehigh Valley Health Network, Allentown, Pa. **Eastern Pennsylvania Gastroenterology and Liver Specialist, Allentown, Pa.METHODSA female with a history of Behcet’s presented with complaints of sharp episodic RLQ pain, abdominal distention and diarrhea. She was pre-scribed mycophenolic acid for episodic presence of oral and vaginal  ulcers due to her Behcet’s. All diagnostic testing was normal. A year later, she presented again with severe RLQ pain. A CT showed appendicular and ileocecal valve wall thickening suspicious for acute appendicitis. Due to the location, an EGD/colonoscopy was performed to rule out IBD, and results were normal. She was told to continue acid suppression medication and an appendectomy was performed.RESULTSThroughout the year, her abdominal pain persisted and repeat CTs and colonoscopies showed cecum wall thickening and persistent  ulceration. Biopsies were negative for IBD and showed focal inflammation. Given her lack of response to immunosuppression, local  resection for definitive therapy is planned.CONCLUSIONDespite the rarity of intestinal involvement in Behcet’s, it should be considered in the differential of abdominal pain. Distinguishing IBD, particularly Crohn’s, from Behcet’s is made difficult by similarities in symptoms and clinical findings. In patients with Behcet’s and complaints of abdominal pain, intestinal involvement should be suspected to avoid unneeded diagnostic testing and treatments.REFERENCES1  Cheon, J.H., and W.H. Kim. “An Update on the Diagnosis, Treatment, and Prognosis of Intestinal Behçet’s Disease.” Current Opinion in Rheumatology. U.S. National Library of Medicine, Jan. 2015. Web. 18 Apr. 2017.2  “Clinical Manifestations and Diagnosis of Behçet’s Syndrome.” Clinical Manifestations and Diagnosis of Behçet’s Syndrome. N.p., n.d. Web. 18 Apr. 2017. 3  Jung, Yoon Suk, Jae Hee Cheon, Soo Jung Park, Sung Pil Hong, Tae Il Kim, and  Won Ho Kim. “Clinical Course of Intestinal Behcet’s Disease During the First Five Years.” SpringerLink. Springer US, 17 Aug. 2012. Web. 18 Apr. 2017. 4  Skef, Wasseem, Matthew J. Hamilton, and Thurayya Arayssi. “Gastrointestinal Behçet’s Disease: A Review.” World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc, 07 Apr. 2015. Web. 18 Apr. 2017. Ileocecal valve thickening noted on initial CT scan.Colonoscopy reveals solitary ileoceacal ulcer (20 mm with no active bleeding)N05375_KyleKreitman_NonhealingUlcer_Poster.indd   1 4/23/18   6:53 PM

The Non-Healing lleocecal Ulcer.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2514&context=medicine

The Non-Healing lleocecal Ulcer.

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