TERMINAL ileitis detected on computed tomography (CT) was associated with Crohn’s disease (CD) in only 12.5% of patients in a 10-year retrospective cohort study, highlighting the broad differential diagnosis of this radiological finding.
Terminal ileitis is a common radiological finding among patients presenting with abdominal pain and altered bowel habits. Although it is often associated with CD, the finding can also reflect infectious, surgical or malignant conditions.
The retrospective cohort study evaluated adult patients with CT-detected terminal ileitis at a single tertiary hospital between 2014 and 2024. Researchers assessed demographic characteristics, laboratory results, stool testing and endoscopic findings, with multivariable logistic regression used to identify predictors of CD.
Among 128 patients included in the study, 16 were ultimately diagnosed with CD. This represented 12.5% of the cohort, indicating that most patients with CT-detected terminal ileitis had another underlying cause.
Among patients without CD, infectious and surgical causes accounted for the most common aetiologies of terminal ileitis, at 27.7% and 17.9%, respectively.
Stool testing within 72 hours of presentation was performed in 48.4% of patients, with pathogens identified in 35.5% of those tested. Endoscopic evaluation was undertaken in 59 patients, representing 46% of the cohort. Histopathological inflammation was identified in 43.5% of biopsied cases.
The findings therefore indicated that CT evidence of terminal ileitis alone did not reliably distinguish CD from other causes. The study also assessed clinical and biochemical factors that could help identify patients more likely to have CD.
Lower albumin levels showed a trend towards an association with CD and were independently associated with the diagnosis in multivariable analysis (odds ratio: 0.82; 95% confidence interval: 0.72–0.94; p=0.004).
By contrast, routine inflammatory markers had limited diagnostic value for identifying CD in patients with terminal ileitis.
The researchers concluded that only a small minority of patients with CT-detected terminal ileitis were diagnosed with CD following further evaluation. Larger prospective studies were recommended to refine diagnostic algorithms and improve identification of CD among patients presenting with this imaging finding.
Reference
Lu I et al. Terminal ileitis on imaging is rarely Crohn’s disease: a 10-year retrospective cohort study. JGH Open. 2026;10(8):e70459.
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