Abstract
Background and Study Aims: This study assesses the diagnostic value of colonoscopy performed at an early stage
of a first attack of acute, severe hemorrhagic colitis.
Patients and Methods: One hundred fourteen consecutive patients were prospectively studied. The colonoscopic
diagnosis was compared with the final diagnosis of the colitis, which was based on
clinical, microbiological, endoscopic, and histological criteria during the acute
illness, but also on the results of a thirty-month follow-up of the patients aiming
to confirm whether the colitis was relapsing or nonrelapsing in nature.
Results: The colonoscopic diagnosis was ulcerative colitis (UC) in 40, Crohn's disease in
four, and infective colitis (IC) in 70 patients. The endoscopic diagnosis was finally
confirmed in all 40 UC patients and in 68 of 70 (97.1 %) IC patients. Two patients
with an initial endoscopic and histological diagnosis of IC presented with typical
attacks of UC 28 and 30 months later, respectively. Prominent endoscopic appearances
in IC were mucosal edema, erythematous areas, hemorrhagic spots, bleeding, microaphthoid
ulcers, and luminal exudate. Although rectal sparing was occasionally seen, endoscopic
lesions were continuous and severe in the distal colon, but were patchily and unevenly
distributed in other parts of the colon in IC. In UC, prominent colonoscopic findings
were bleeding, mucosal friability, granularity, and ulceration; lesions were continuously
distributed in the involved area.
Conclusions: Colonoscopy is a useful procedure in the differential diagnosis of severe bloody
diarrhea of unknown cause.
