Abstract
In this paper we describe an endoscopic appearance of the sigmoid colon characterised by mucosal swelling, erythema and haemorrhage strictly localised to the crescentic mucosal folds. In a 5-year period these changes were seen in 34 (1.42%) of 2380 colonoscopies and fibreoptic sigmoidoscopies. The majority of patients were middle-aged or elderly. Diverticular disease was present in most (82%) but the abnormalities were confined to the crescentic mucosal folds with sparing of the diverticular orifices. The majority of patients presented with a history of bleeding per anum. Histologically there was a spectrum of changes varying from minor vascular congestion to florid active inflammatory disease with crypt architectural abnormalities mimicking ulcerative colitis, but rectal biopsies were invariably normal. Three patients later progressed to typical distal ulcerative colitis and two other patients presenting to us with endoscopic crescentic fold disease had a previous histologically documented history of distal ulcerative colitis. In three patients the histological features were of mucosal prolapse. About half the patients required some form of therapy to control their symptoms. Steroids and/or sulphasalazine were of value although two patients subsequently underwent sigmoid resection, one to control bleeding and the second for a diverticulosis-associated stricture. Whilst endoscopic crescentic fold disease represents a specific endoscopic appearance the clinical and histological features indicate a wide spectrum of disease.
Résumé
Dans ce papier nous décrivons un aspect endoscopique du colon sigmoïde caractérisé par une enflure de la muqueuse, un érythème et des hémorragies strictements localisées aux plis muqueux en croissant. Durant une période de trois ans ces modifications ont été retrouvées chez 34 (1,42%) de 2380 coloscopies ou sigmoïdoscopies. La majorité des patients étaient d'un age moyen ou âgé. Une maladie diverticulaire était présente chez la plupart d'entre eux (82%) mais les anomalies étaient localisées aux plis muqueux en croissant épargnant les orifices diverticulaires. La majorité des patients présentaient une histoire d'hémorragie par l'anus. Histologiquement il y avait une variété de modifications allant d'une congestion vasculaire mineure à une inflammation active avec des anomalies architecturales décrites simulant la colite ulcéreuse, mais les biopsies rectales étaient invariablement normales. Trois malades ont fait par la suite une colite ulcérative distale typique et deux autres se présentant à nous avec une maladie endoscopique des plis en croissant avaient une préalable histoire documentée histologiquement de colite ulcérative distale. Ches trois patients les aspects histologiques étaient ceux d'un prolapsus muquene environ la moitié des patients ont en besain d'une thérapié quelconque pour contrôler leurs symptomes. Les stéroïdes et/ou la sulfasalazine fûrent actifs bien que deux patients subirent par la suite une résection sigmoïdienne, l'un pour contrôler une hémorragie et le second pour une sténose diverticulaire associée. Tandis que la maladie endoscopique des plis en croissant représente un aspect spécifique de l'endoscopie, les aspects cliniques et histologiques révèlent une large variété de maladies.
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Gore, S., Shepherd, N.A. & Wilkinson, S.P. Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance. Int J Colorect Dis 7, 76–81 (1992). https://doi.org/10.1007/BF00341290
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DOI: https://doi.org/10.1007/BF00341290