Ulcerative colitis with skip lesions at the mouth of the appendix. Some of the gross and microscopic features that are useful in distinguishing the two diseases in the chronic state are common to both in the fulminant or refractory phase. V shaped clefts that may extend into submucosa or muscularis propria with overhanging edges. Retrieved from Feller, M. Frequency and clinical evolution of indeterminate colitis: Sampling of the terminal ileum is helpful, because it is usually uninvolved in UC with a caecal patch. Histological patchiness and sparing of the rectum in ulcerative colitis:

In the subgroup with relative rectal sparing, the description of the rectal mucosa was not very detailed. Most of these patients retained the diagnosis of IC during their further clinical course, perhaps reflecting a distinct clinicoserological entity. However, if terminal ileal and intervening colonic mucosal biopsies are not available, a diagnosis of IBD is made but importantly without favouring CD. Colorectal inflammation and increased cell proliferation associated with oral sodium phosphate bowel preparation solution. When there is no previous clinical diagnosis, or in a first attack that is fulminant, colitis may have features that are found commonly, irrespective of the aetiology. They tend to be non-contributory when most needed IC should not be regarded as a contraindication for ileal pouch anal anastomosis IPAA.

Diagnostic difficulty arising from rectal recovery in ulcerative colitis.

Crohn’s Disease A Case Study – ppt download

In general, we do not regard IC as a contraindication for a pouch. Int J Colorectal Dis ; A previous study with similar data showed an incidence of only 2.

ibd case study slideshare

Price had proposed that the term should be used slidezhare a pending tray diagnosis, representing diagnostic inadequacy, and not as a specific nosological entity. It has been shown that the microscopic features used for the diagnosis of IBD are often not present in the very early stage of disease, 36 especially in children.


Note the almost normal or minimally involved mucosa. Because there cqse be overlapping features of UC and CD in the colons of some patients, the term indeterminate colitis IC was coined in an attempt to classify these entities more effectively.

It may be difficult, if not impossible, to distinguish ischaemia from IBD histologically.

Indeterminate colitis

Appendiceal orifice inflammation as a skip lesion in ulcerative colitis: Surawicz CMBelic L. It should be emphasised that these are opinions and personal observations that are not necessarily supported by existing studies, and as such we acknowledge that some slidesjare disagree with them.

About project SlidePlayer Terms of Service.

ibd case study slideshare

In practice, this may occur at the time of examination of endoscopic biopsies in the non-fulminant setting, and not just upon examination of colectomy specimens resected for fulminant disease. Patients with an initial diagnosis of IC and negative serology were more likely to retain the diagnosis of IC.

Crohn’s Disease A Case Study

To slideeshare this website, you must agree to our Privacy Policyincluding cookie policy. A Mucosal changes are minimal, without mucin depletion, and with only slight architectural distortion. Antibiotics are known to cause diarrhea so it is imperative that we use these researched antibiotics to prevent this as much as possible.

Most of these patients retained the diagnosis of IC during their further clinical course, perhaps reflecting a distinct clinicoserological entity.

Indeterminate colitis

These include the more common features such as IBD in the fulminant or refractory phase, but also IBD in the chronic phase, and the effects of treatment on the histology of IBD, especially UC, which can result in pronounced focality, relative rectal sparing, and focal healing. The islands of surviving mucosa were only mildly inflamed, with a regular glandular pattern and preserved goblet cells—features that favoured CD, or disease in mucosa that was previously unaffected by the disease process, conceivably including fulminant infections by organisms that were not identified on routine stool culture.


Traditionally, inflammation in the upper gastrointestinal tract in children, in whom Helicobacter pylori infection is fairly uncommon, was tantamount to a diagnosis of CD.

Colorectal mass lesions masquerading as chronic inflammatory bowel disease on mucosal biopsy. Residual mucosa in a colectomy specimen from fulminant inflammatory bowel disease.

The importance of diagnostic accuracy in colonic inflammatory bowel disease. Suggest consider delaying the restorative procedure for 6—12 months at which time other slideshhare of CD should be sought if this will preclude the IPAA.

ibd case study slideshare

Retrieved from Feller, M. The differential diagnosis in such cases should include IBD, in addition to forms of colitis that can occur as fulminant disease, such as colitis caused by infection for example, Clostridium difficilesalmonellosis, shigellosis, and Escherichia coli and drugs, such as non-steroidal anti-inflammatory drugs NSAIDs. Focal gastric inflammatory slideshzre in inflammatory bowel diseases: Sampling studh the terminal ileum is helpful, because it is usually uninvolved in UC with a caecal patch.

There is no clear agreement on the diagnostic criteria for excluding IBD, especially in patients with colonic disease only. The number of paraffin wax blocks for each surgical colectomy specimen varied greatly, between two and These features, although not diagnostic of CD, are sufficient to raise the possibility of CD, despite the lack of other evidence in the colon. Medicine, 39 Gastroenterology Part 3 of 4doi: Findings in uneven disease pattern in indeterminate colitis from Price 6.