THE ROLE OF COLONOSCOPY IN THE DIFFERENTIAL-DIAGNOSIS OF ACUTE, SEVERE HEMORRHAGIC COLITIS

Background and Study Aims: This study assesses the diagnostic value of colonoscopy performed at an early stage of a first attack of acute, s evere hemorrhagic colitis. Patients and Methods: One hundred fourteen consecutive patients were prospectively studied, The colonoscopic diag nosis was compared with the final diagnosis of the colitis, which was based on clinical, microbiological, endoscopic, and histological crite ria during the acute illness, but also on the results of a thirty-mont h follow-up of the patients aiming to confirm whether the colitis was relapsing or nonrelapsing in nature. Results: The colonoscopic diagnos is was ulcerative colitis (UC) in 40, Crohn's disease in four, and inf ective colitis (IC) in 70 patients, The endoscopic diagnosis was final ly confirmed in all 40 UC patients and in 68 of 70 (97.1%) IC patients , Two patients with an initial endoscopic and histological diagnosis o f IC presented with typical attacks of UC 28 and 30 months later, resp ectively, Prominent endoscopic appearances in IC were mucosal edema, e rythematous areas, hemorrhagic spots, bleeding, microaphthoid ulcers, and luminal exudate. Although rectal sparing was occasionally seen, en doscopic lesions were continuous and severe in the distal colon, but w ere patchily and unevenly distributed in other parts of the colon in I C. In UC, prominent colonoscopic findings were bleeding, mucosal friab ility, granularity, and ulceration; lesions were continuously distribu ted in the involved area. Conclusions: Colonoscopy is a useful procedu re in the differential diagnosis of severe bloody diarrhea of unknown cause.