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[Ischemic-granulomatous colitis: a new differential diagnosis from Crohn's colitis?].
Schweiz Med Wochenschr. 1987 Apr 25; 117(17):643-50.SM

Abstract

In patients with inflammatory bowel disease the presence of epitheloid cell granuloma is considered to be the most reliable single criterion for the presence of Crohn's disease. We report on 6 patients (5 female, 1 male, mean age 73.5 years) with acute onset of inflammatory bowel disease, in whom the presence of epitheloid cell granuloma led to the diagnosis of Crohn's disease. However, concomitant major bleeding (4/6), absence of small intestinal involvement, and absence of extraintestinal manifestations suggested the presence of ischemic colitis. Histologic findings including thrombosed vessels (6/6), mucosal (5/6) and submucosal (3/4) hemorrhage, and mucosal (3/6) and submucosal (3/4) fibrosis supported this diagnosis. A review of the literature suggests that many clinical features of assumed Crohn's disease in elderly patients are atypical and would be most consistent with an ischemic pathogenesis: rarity of fistula, low recurrence rate, low rate of small intestinal involvement and extra-intestinal manifestations, and increased incidence of major colonic bleeding would best fit with an ischemic pathogenesis in at least some of these patients. We suggest that in elderly patients with "Crohn's colitis", even in the presence of epitheloid cell granuloma, an ischemic etiology should be considered.

Authors

Heer M
No affiliation info available
Sulser H
No affiliation info available
Krampf K
No affiliation info available
Thür C
No affiliation info available
Osterwalder C
No affiliation info available
Hany A
No affiliation info available

MeSH

Age FactorsAgedAged, 80 and overColitisColitis, UlcerativeColonColonic DiseasesCrohn DiseaseDiagnosis, DifferentialGastrointestinal HemorrhageGranulomaHumansIschemiaMiddle Aged

Pub Type(s)

English Abstract
Journal Article

Language

ger

PubMed ID

3495882

Citation

Heer, M, et al. "[Ischemic-granulomatous Colitis: a New Differential Diagnosis From Crohn's Colitis?]." Schweizerische Medizinische Wochenschrift, vol. 117, no. 17, 1987, pp. 643-50.
Heer M, Sulser H, Krampf K, et al. [Ischemic-granulomatous colitis: a new differential diagnosis from Crohn's colitis?]. Schweiz Med Wochenschr. 1987;117(17):643-50.
Heer, M., Sulser, H., Krampf, K., Thür, C., Osterwalder, C., & Hany, A. (1987). [Ischemic-granulomatous colitis: a new differential diagnosis from Crohn's colitis?]. Schweizerische Medizinische Wochenschrift, 117(17), 643-50.
Heer M, et al. [Ischemic-granulomatous Colitis: a New Differential Diagnosis From Crohn's Colitis?]. Schweiz Med Wochenschr. 1987 Apr 25;117(17):643-50. PubMed PMID: 3495882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Ischemic-granulomatous colitis: a new differential diagnosis from Crohn's colitis?]. AU - Heer,M, AU - Sulser,H, AU - Krampf,K, AU - Thür,C, AU - Osterwalder,C, AU - Hany,A, PY - 1987/4/25/pubmed PY - 1987/4/25/medline PY - 1987/4/25/entrez SP - 643 EP - 50 JF - Schweizerische medizinische Wochenschrift JO - Schweiz Med Wochenschr VL - 117 IS - 17 N2 - In patients with inflammatory bowel disease the presence of epitheloid cell granuloma is considered to be the most reliable single criterion for the presence of Crohn's disease. We report on 6 patients (5 female, 1 male, mean age 73.5 years) with acute onset of inflammatory bowel disease, in whom the presence of epitheloid cell granuloma led to the diagnosis of Crohn's disease. However, concomitant major bleeding (4/6), absence of small intestinal involvement, and absence of extraintestinal manifestations suggested the presence of ischemic colitis. Histologic findings including thrombosed vessels (6/6), mucosal (5/6) and submucosal (3/4) hemorrhage, and mucosal (3/6) and submucosal (3/4) fibrosis supported this diagnosis. A review of the literature suggests that many clinical features of assumed Crohn's disease in elderly patients are atypical and would be most consistent with an ischemic pathogenesis: rarity of fistula, low recurrence rate, low rate of small intestinal involvement and extra-intestinal manifestations, and increased incidence of major colonic bleeding would best fit with an ischemic pathogenesis in at least some of these patients. We suggest that in elderly patients with "Crohn's colitis", even in the presence of epitheloid cell granuloma, an ischemic etiology should be considered. SN - 0036-7672 UR - https://www.unboundmedicine.com/medline/citation/3495882/[Ischemic_granulomatous_colitis:_a_new_differential_diagnosis_from_Crohn's_colitis]_ DB - PRIME DP - Unbound Medicine ER -