Differential Diagnosis for Ulcers at IVC and Terminal Ileum on Colonoscopy
- Single Most Likely Diagnosis
- Crohn's Disease: This is the most likely diagnosis due to the presence of ulcers in the terminal ileum, a common location for Crohn's disease, and the involvement of the ileocecal valve (IVC), which is consistent with the disease's tendency to affect the ileocecal region.
- Other Likely Diagnoses
- Ulcerative Colitis with Backwash Ileitis: Although ulcerative colitis primarily affects the colon, backwash ileitis can cause inflammation and ulcers in the terminal ileum, making it a possible diagnosis.
- Infectious Ileitis (e.g., Yersinia, Salmonella, Campylobacter): These infections can cause ulcers in the ileum and may involve the IVC, especially if the infection is severe or the patient is immunocompromised.
- NSAID-induced Ulcers: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers throughout the gastrointestinal tract, including the terminal ileum and IVC, especially with long-term use.
- Do Not Miss Diagnoses
- Intestinal Lymphoma: Although rare, lymphoma can cause ulcers in the ileum and IVC, and missing this diagnosis could have severe consequences due to the need for prompt treatment.
- Intestinal Tuberculosis: This condition can mimic Crohn's disease and cause ulcers in the ileum and IVC, making it essential to consider, especially in endemic areas or in patients with risk factors.
- Amyloidosis: Systemic amyloidosis can involve the gastrointestinal tract and cause ulcers, including in the terminal ileum and IVC, which could be life-threatening if not recognized.
- Rare Diagnoses
- Behçet's Disease: A rare condition characterized by multisystem inflammation, including gastrointestinal involvement, which can cause ulcers in the ileum and IVC.
- Eosinophilic Gastroenteritis: A rare condition involving eosinophilic infiltration of the gastrointestinal tract, which can cause ulcers and inflammation in the ileum and IVC.
- Chronic Ischemic Bowel Disease: Rarely, chronic ischemia can cause ulcers in the terminal ileum and IVC, especially in patients with significant vascular disease.