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Ulcerative and "Granulomatous" Colitis—Validity of Differential Diagnostic Criteria: A Study of 100 Patients Treated by Total Colectomy

HOWARD SCHACHTER, M.D.; MELVIN J. GOLDSTEIN, M.D., F.A.C.P.; HENRY RAPPAPORT, M.D., F.A.C.P.; JOHN J. FENNESSY, M.B.; and JOSEPH B. KIRSNER, M.D., F.A.C.P.
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Presented in part April 22, 1969, at the 50th Annual Session of the American College of Physicians, Chicago, Ill.

▸Requests for reprints should be addressed to Joseph B. Kirsner, M.D., University of Chicago Hospitals, 950 E. 59th St., Chicago, Ill. 60637


Chicago, Illinois


Ann Intern Med. 1970;72(6):841-851. doi:10.7326/0003-4819-72-6-841
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One hundred cases of inflammatory disease of the colon treated by proctocolectomy were subjected to clinical, radiologic, and pathologic restudy. Twenty-one of the 100 cases were diagnosed clinically as Crohn's disease ("granulomatous colitis"), with frequent but not invariable radiologic agreement. Only 14 of the 21 clinically diagnosed patients had cumulative histologic features of "granulomatous colitis." Seventy-nine of the 100 cases were diagnosed clinically as ulcerative colitis, again with frequent but not complete radiologic agreement. Four of the 79 patients presented cumulative histologic features of granulomatous colitis. In 11 of the 100 cases segmental disease or a normal rectum was described at gross examination. Only four of these cases were diagnosed histologically as granulomatous colitis. Patients with granulomatous colitis constitute a small segment of the patient population with inflammatory bowel disease requiring proctocolectomy at our hospital. Currently accepted gross and histologic characteristics of Crohn's disease, including the granuloma, sometimes do not correlate with clinical findings, although correlation is improved when collective criteria are utilized. Significant overlap exists between granulomatous and ulcerative colitis clinically, radiologically, and pathologically.

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