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Enteitis

Enteitis ultrasound case study

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Reporting Panel

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Bowel Pathology

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USG

Enteitis ultrasound case study

CASE–1

Clinical History

A 32-year-old patient presented with acute abdominal pain, diarrhea, nausea, vomiting, and low-grade fever. The patient was referred for abdominal ultrasound to evaluate suspected bowel inflammation and exclude other causes of acute abdomen.

Ultrasound Findings

Ultrasound examination demonstrates segmental circumferential thickening of the small bowel wall involving the terminal ileum with preserved mural stratification. The affected bowel loops show increased vascularity on Color Doppler (hyperemia). Mild adjacent mesenteric fat echogenicity and a few reactive mesenteric lymph nodes are noted. Trace free fluid is present within the right iliac fossa. No bowel dilatation, abscess, perforation, or appendiceal abnormality is identified.

Ultrasound of the small bowel. Segmental bowel wall thickening with preserved mural stratification and increased Color Doppler vascularity is demonstrated, consistent with enteritis. Mild surrounding mesenteric inflammatory changes and reactive lymph nodes are also noted.

Report Line

Segmental circumferential thickening of the small bowel with preserved mural stratification and increased mural vascularity is noted. Mild adjacent mesenteric inflammatory changes, reactive mesenteric lymph nodes, and minimal free fluid are present. No evidence of bowel obstruction, perforation, or localized abscess. Sonographic findings are consistent with enteritis.

Impression

Features are consistent with acute enteritis involving the small bowel, with associated mild mesenteric inflammatory changes and reactive mesenteric lymphadenopathy.

Recommendation

Clinical correlation with history, physical examination, and laboratory findings (CBC, CRP, ESR, and stool examination/culture where indicated) is recommended. Adequate hydration and appropriate medical treatment should be instituted. CT abdomen with contrast may be considered if symptoms worsen or if complications such as obstruction, perforation, abscess formation, or inflammatory bowel disease are suspected.

Key Learning Points

• Enteritis commonly appears on ultrasound as segmental bowel wall thickening (>3 mm) with preserved mural stratification.
• Color Doppler typically demonstrates increased mural vascularity due to active inflammation.
• Reactive mesenteric lymph nodes and increased echogenicity of adjacent mesenteric fat are common associated findings.
• Small-volume free intraperitoneal fluid may be present in acute inflammatory bowel disease.
• Ultrasound is useful for evaluating bowel inflammation without radiation exposure, particularly in young patients.
• CT enterography or MR enterography may be required if Crohn's disease or complications are suspected.
• Clinical correlation is essential to differentiate infectious enteritis from inflammatory bowel disease or ischemic bowel disease.