Crohn’s colitis affects about 15% of Crohn’s patients and is confined to any segment of the colon between the cecum and rectum. It presents with a bimodal age distribution, the first and most common between ages 15 and 30 and second between 55 and 80 years. Clinical manifestations include abdominal pain, diarrhea, weight loss, and fevers. Macroscopic features include a thickened colon wall, aphthous ulcers, cobblestone appearance of the mucosa, mesenteric fat creeping, and presence of strictures and fistulae. Microscopically they present with focal full-thickness inflammation, mucosal ulceration, and lymphocytic proliferation that can lead to granulomas. Diagnosis is established with a combination of endoscopic and radiologic findings as well as laboratory markers. Medical management consists of antibiotics, sulfa drugs, steroids, immunomodulators, or biologic therapy. Surgery is not curative and therefore should only be considered in patients who fail medical management and develop complications such as stricture, perforation or symptomatic fistulizing disease, and dysplasia or malignancy.
KeywordsCrohn’s colitis Crohn’s disease Colitis Colorectal malignancy Inflammatory bowel disease Fulminant colitis Toxic megacolon Total proctocolectomy Total abdominal colectomy
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