Disease
Differential diagnosis
Ischemic colitis
Clinical symptoms, abrupt transition to normal mucosa with sparing rectum
Radiation proctitis
A history of exposure to radiation
Lymphoma
Clinical symptoms
Vasculitis
Clinical symptoms and signs of systemic disease
Infectious colitis
Clinical symptoms and signs
Drug-induced colitis
A history of NSAID use
5.1 Ischemic Colitis
5.1.1 Clinical Manifestations
Ischemic colitis is caused by reduction in blood flow into the colon, which often affects the elderly [1, 2]. Patients with age older than 60; patients who are on hemodialysis; those with hypertension, hypoalbuminemia, or diabetes mellitus; and those who are taking constipation-inducing or constipation-relieving medications have been known as risk factors. The typical presentations are a sudden and cramping abdominal pain with an urgent desire to defecate and passage of bright red or bloody diarrhea. Other manifestations include systemic symptoms such as fever, hypotension, or shock due to bowel necrosis, perforation, peritonitis, and sepsis.
5.1.2 Endoscopic Features
The splenic flexure, descending colon, and sigmoid colon, which are called as the “watershed” area, are most commonly involved, whereas the rectum is usually spared [3, 4]. Endoscopic appearances include edematous and friable mucosa, erythema, scattered erosions, ulcerations, petechial hemorrhages, and purple hemorrhagic nodules. These endoscopic findings are typically limited to the affected mucosa with abrupt transit to normal mucosa (Fig. 5.1).
Fig. 5.1
Ischemic colitis. (a) Erythematous and edematous mucosa is noted in the sigmoid colon with petechial hemorrhages. (b) Discrete ulceration is noted with demarcated normal mucosa. (c) Friable and edematous mucosa with erosion is noted in the sigmoid colon. The affected mucosa was abruptly transit to normal mucosa. (d) Edematous and erythematous mucosa with ease touch bleeding is noted in the sigmoid colon, mimicking ulcerative colitis
5.2 Radiation Proctitis
5.2.1 Clinical Manifestations
Radiation injury to the colorectum results from epithelial damage following radiation treatment of cancers located in the rectum, anus, cervix, uterus, prostate, urinary bladder, or testis [1, 2]. The rectum and sigmoid colon are most frequently affected. Acute radiation injury occurs during or within 6 weeks of radiation treatment. Chronic injury usually occurs 9–14 months after radiation treatment but can occur any time postirradiation up to 30 years after exposure. Clinical symptoms of radiation proctitis include diarrhea, mucus discharge, urgency, tenesmus, and bleeding.
5.2.2 Endoscopic Features
Endoscopic findings include mucosal friability, pallor, and telangiectasias [3, 4]. These lesions tend to be continuous but can vary in intensity. Chronic radiation proctitis shows various manifestations from pallor mucosa with telangiectasia to ulceration, fistula, stricture, and mucosal bleeding (Fig. 5.2).
Fig. 5.2
Radiation proctitis. (a) Pale mucosa with telangiectasia is observed in the rectum. (b) Telangiectasia with oozing blood is noted in the rectum. (c) Pale mucosa with telangiectasia is noted in the sigmoid colon. The sigmoid colon looks like a pipe without mucosal folds, mimicking long-standing ulcerative colitis. (d) A geographic ulcer with surrounding mucosal edema and erythema is noted in the rectum. (e) Ulcer scarring with deformity is noted at rectum. Surrounding mucosa shows typical pale and telangiectatic change. (f) Chronic radiation injury evokes circumferential ulceration with stricture in the rectosigmoid junction. The scope could not be passed through the stricture
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
