Published in:
01-02-2020 | Ileocolonoscopy | The Last Image
The cecal patch: a signature skip lesion in ulcerative colitis
Published in: Techniques in Coloproctology | Issue 2/2020
Login to get accessExcerpt
Endoscopic and/or pathologic characterization and classification of inflammatory bowel disease is fundamental to establish an unequivocal diagnosis and provide appropriate treatment (Fig. 1). Non-transmural and continuous inflammatory involvement of variable length from the supra-anal rectum is a characteristic hallmark of ulcerative colitis (UC) [1]. However, a “cecal patch” of circumscript periappendiceal inflammation, potentially related to physiological immune cell abundancy, is a signature skip lesion (besides “backwash ileitis”), breaking the rule of continuity in UC and should be known to coloproctologists and pathologists alike [2].
Fig. 1
A 50-year-old male with lower abdominal discomfort and bloody diarrhea underwent ileocolonoscopy for suspected inflammatory bowel disease. Continuous inflammatory changes, such as loss of vascularity, granularity, erythema, exudates with erosions, were noted throughout the rectum and were highly suggestive of ulcerative proctitis. a While the remaining ileocolon was completely unremarkable, in the cecum, a “patch” of inflammation was noticed around the appendiceal orifice with the same endoscopic appearance as in the rectum. b Endoscopic diagnosis was ulcerative colitis (UC) with a “cecal patch”. Histopathology of rectal (c) and periappendiceal (d, H and E × 5, each) biopsies revealed similar changes typical of UC with chronic inflammation as well as crypt distortion with abscesses, and systematic and topical 5-aminosalicylate treatment was initiated
× ![]()
…