Case vignette of presentation with terminal ileum inflammatory mass

To see our latest courses, or to donate to the St Mark's Hospital Foundation, please visit our channel description for details. Title: Case vignette of presentation with terminal ileum inflammatory mass Speaker: Ravi Misra Event: Frontiers in Colorectal and Intestinal Disease 2024 Year: 2024 The presentation explores three complex small‑bowel cases to demonstrate how difficult it can be to distinguish inflammatory bowel disease from alternative causes of ileal thickening, emphasising the need for a multidisciplinary approach involving radiology, pathology and clinical teams. The first case follows a patient with shifting ileal inflammation, rash, joint pain and a dramatic steroid response, whose investigations ultimately revealed leukocytoclastic vasculitis rather than Crohn’s disease, highlighting how systemic vasculitides can mimic gastrointestinal pathology. The second case describes a patient with an ileocaecal stricture and apical lung changes initially treated as tuberculosis, but with no microbiological confirmation and progressive obstruction, ultimately requiring surgery that showed no evidence of TB and raised the likelihood of Crohn’s disease after months of diagnostic uncertainty. The final case involves a patient with longstanding Crohn’s disease and multiple strictures whose resection unexpectedly revealed a poorly differentiated signet‑ring cell adenocarcinoma arising within chronically inflamed bowel, illustrating how malignancy can be hidden within fibrotic Crohn’s strictures. Across all cases, the speaker stresses that radiological patterns, histology, clinical evolution and treatment response must be integrated to avoid misdiagnosis and ensure timely, appropriate management.