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DIFFERENTIAL

IBS, ulcerative colitis, infectious enterocolitis (Yersiniasp., TB, Entamoeba

histolytica, etc), celiac sprue, lymphoma, mesenteric ischemia, carcinoma of

the colon

DIAGNOSIS

■ Anemia, leukocytosis, elevated ESR and CRP, B12 deficiency

■ Colonoscopy reveals skip lesions, linear ulcerations, and granulomas, par-

ticularly, at the terminal ileum.

■ Biopsy demonstrates chronic and acute inflammation and evaluates for the

presence of colorectal cancer.

■ Small bowel follow-through (SBFT)

■ CT scan evaluation for abscess, mesenteric inflammation, obstruction, and

fistulas

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

TABLE 11.3. Distinguishing Features of IBD

FEATURE CROHNDISEASE ULCERATIVECOLITIS

Age at onset Bimodal: 15–25, 55–65 yr Bimodal: 20–40, 60–70 yr

Abdominal pain Sharp, focal Crampy, associated with bowel movement

Bowel obstruction Common Rare

Gross hematochezia Occasionally Common

GI involvement Mouth to anus; typically terminal Colon only; rectum always involved with continuous

ileum/proximal colon; perianal progression proximally Perianal involvement uncommon

involvement common

Abscesses Common Uncommon

Pattern Segmental, transmural, Eccentric

Ulceration Superficial to deep, Superficial

linear, serpiginous

Histology Noncaseating granulomas Crypt abscesses

Fistula/stricture Common Uncommon

Toxic megacolon Uncommon Common

Extraintestinal Uncommon Common

manifestations

Infliximab response Often Occasionally

Surgery curative Never Often