Acute toxic dilatation limited to the ileum in Crohn's disease

Two patients are presented with a previously undescribed grave complication of Crohn's disease, which we have termed toxic dilatation of the ileum because of its resemblance both clinically and radiographically to toxic dilatation of the colon. This entity is characterized clinically by the rapid onset of marked toxicity, fever and severe abdominal distention with pain, tenderness and diarrhea, occurring during the course of Crohn's disease. Radiographically, these patients showed severe ulceration, edema and marked dilatation, limited to the ileum in the absence of any similar alterations in the colon, distal mechanical obstruction, electrolyte disturbance or other obvious precipitating cause. Prompt and vigorous treatment with small bowel intubation, high doses of parenteral steroids and antibiotics, plus appropriate fluid and electrolyte therapy, produced clinical and radiographic improvement with restoration of the small bowel to its former state in both instances.