Diagnosis of Granulomatous Colitis: With special reference to value of fibercolonoscopy K. Watanabe 1 , H. Imai 1 , M. Numazawa 1 , T. Narasaka 1 , J. Uezu Mabune 1 , K. Shoji 1 , M. Ishikawa 1 , S. Yamagata 1 1The Medical Department of Prof. S. Yamagata, Tohoku University School of Medicine pp.883-893
Published Date 1974/7/25
DOI https://doi.org/10.11477/mf.1403111949
  • Abstract
  • Look Inside

 In order to clarify the significance of fibercolonoscopy in determining a diagnosis of granulomatous colitis, the pathological, radiological, endoscopic and clinical differences between granulomatous colitis and ulcerative colitis were investigated. Namely, observations were made on 12 cases of granulomatous colitis and 23 cases of ulcerative colitis, who had had colonic resections between 1954 and 1973.

 The findings noted lead to the diagnostic differentiation between the two conditions as follows: Granulomatous colitis is characterized by cobblestone-like or gyrous lesions distributed segmentally along the length of the bowel, without involving the rectum. The lesions of granulomatous colitis lack hemorrhage or suppuration, show a microscopic evidence of transmural inflammation and noncaseating granuloma formation, and are observed to have fissuring, probably an early stage of fistula, and stricture. The characteristic features also include negative tuberculin tests, diarrhea with no evidence intestinal bleeding, a palpable mass in the abdomen and involvement of the small intestine. In ulcerative colitis, by contrast, lesions are continuous and symmetrically distributed including the rectum. They either have a rough or granular surface or present features characteristic of pseudopolyposis, and show hemorrhage and suppuration. Inflammation is limited to the mucosa and submucosa with no evidence of noncaseating granulomas, fissuring, fistula or stricture. Blood in the stool and no involvement of the small intestine except backwash ileitis are also characteristic features of ulcerative colitis. As a consequence of assessments made of the various diagnostic techniques as to usefulness in differential diagnoses between the two disease states, it was noted that fibercolonoscopy and biopsy under direct vision with it applied in conjunction with the conventional procedures readily facilitate the differential diagnosis without any surgical intervention, in practically all aspects but the depth of inflammatory involvement. However, the depth of the inflamed lesion can also be estimated indirectly. It seems to follow that it is practicable to make the differential diagnosis between the two conditions even prior to colectomy, with the exception of atypical forms which present overlapping findings.

 Fibercolonoscopy is thus of remarkably great value in the diagnosis of granulomatous colitis insomuch as examination of the affected large intestine for appearance of lesions and to look for noncaseating granuloma formation can be accomplished only by this procedure combined with biopsy under direct vision.

Copyright © 1974, Igaku-Shoin Ltd. All rights reserved.


電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院