We propose to describe, in its pathologic and clinical details, a disease of the terminal ileum, affecting mainly young adults, characterized by a subacute or chronic necrotizing and cicatrizing inflammation. The ulceration of the mucosa is accompanied by a disproportionate connective tissue reaction of the remaining walls of the involved intestine, a process which frequently leads to stenosis of the lumen of the intestine, associated with the formation of multiple fistulas.
The disease is clinically featured by symptoms that resemble those of ulcerative colitis, namely, fever, diarrhea and emaciation, leading eventually to an obstruction of the small intestine; the constant occurrence of a mass in the right iliac fossa usually requires surgical intervention (resection). The terminal ileum is alone involved. The process begins abruptly at and involves the ileocecal valve in its maximal intensity, tapering off gradually as it ascends the ileum orally for from 8 to 12 inches (20