Colitis—Inflammatory Bowel Diseases and Other Forms of Colitis

쐍 12.9 cont.

d e
d, e Florid inflammation in anastomotic region. d View into the ascending colon toward f Chronic ulcer at ileocolonic anastomosis,
anastomosis. e View into neoterminal ileum, highly florid attack, but without significant no stenosing tendency for years.
narrowing (which, however, is imminent in the course of disease).
Pathological Findings

Differential Diagnosis of Chronic IBD Types and Table 12.2 Colonoscopy features for differential diagnosis of UC and
CD (modified according to reference 8)
Other Forms of Inflammatory Bowel Diseases
Feature Ulcerative colitis Crohn disease
쮿 Differential Diagnosis: Ulcerative Colitis vs. Continuous inflammation always* extremely rarely
Crohn Disease Patchy manifestation no* frequent
III Tables 12.1, 12.2 display major characteristics for distinguishing
Rectal involvement almost always often spared

between the two main types of chronic IBD. Vascular pattern distorted or lost often normal
Diffuse bleeding widespread rare
Vulnerability widespread uncommon
Spontaneous petechiae widespread rare
Granularity widespread less widespread
Table 12.1 Endoscopic differential diagnosis CD−UC (based on refer- Erythema typical less typical
ence 8) Edema present present
Factors supporting a diagnosis Factors supporting a diagnosis
Cobblestoning no typical
of CD of UC
Aphthous erosions no typical
왘 key finding: patchy, discon- 왘 continuous, symmetrical,
Surface ulcerations occasionally frequent
tinuous and segmental diffuse inflammation
spread of inflammation Large ulcers 쏜 1 cm in severe cases common
Long, deep ulcers rare common
왘 areas of normal mucosal in- 왘 mucosa in affected segment
terspersed with ulcerations; noticeably different from the Linear ulcers rare common
or asymmetrical distribution surrounding mucosa, sharp Serpiginous ulcers rare common
of ulcerations in a given demarcation to proximal, Pseudopolyps not infrequent occasionally
segment uninvolved mucosa
Mucosal bridging occasionally occasionally
왘 rectum is spared 왘 diffuse rectal involvement Mucosa surrounding ulcer abnormal normal
왘 ulceration surrounded by 왘 ulceration on a background Sharp demarcation (circu- yes no
relatively normal mucosa, no of diffuse abnormal mucosa lar) to normal tisse
marked increase in vulnera- with reddening, vulnerability, Stricture no common, frequent
bility of surrounding mucosa and granularity
왘 This difference is vital
왘 deep, widespread ulcerations 왘 attention: these factors for the patient: stricture
왘 ulcerations and stenosis or usually support a diagnosis related to UC may be
distortion of the Bauhin valve of UC, but there are always malignant!
exceptions!
* For exceptions, see sections concerning UC.

쐽 106

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