Segmental colitis.

Abstract

The purpose of this paper is to demonstrate the roentgen features of chronic colitis involving limited portions of the colon. Numerous terms have been used to describe this condition, namely, right-sided ulcerative colitis, regional colitis, Crohn's disease of the colon, segmental colitis. When there is simultaneous involvement of the small bowel, enterocolitis and ileocolitis have been included. Of these various terms, “segmental colitis” has become the most popular. We define segmental colitis as a chronic, non-specific inflammatory process involving a limited portion of the colon. The pathologists at this hospital (Mount Sinai, New York) have reported these cases as ulcerative, resembling universal ulcerative colitis, or granulomatous, akin to regional enteritis. At the present time, we do not consider segmental colitis as a separate disease entity. One hundred and forty-six cases of limited colitis have been studied, exclusive of isolated involvement of the rectum and sigmoid. This report represents a preliminary attempt to distinguish, on a roentgen basis, segmental ulcerative colitis from segmental granulomatous colitis. It should be noted that in many instances this differentiation is impossible. The effort to distinguish the two would appear, however, to be of practical usefulness because of the variations in clinical behavior, prognosis, and treatment. History Diffuse ulcerative colitis was described in 1880 in a textbook of pathology by Wilks and Moxon (1) and there have been a tremendous number of articles on this topic since that time. On the subject of limited colitis, the literature is relatively scanty. From 1890 to 1930, only scattered case reports of localized inflammatory disease of the colon appeared. The hyperplastic or granulomatous nature of the lesion was emphasized, as well as its resemblance to carcinoma and to tuberculosis. In 1930 Bargen and Weber (2) described a group of these cases, emphasizing the lack of involvement of the rectum and sigmoid. To this entity they applied the term “regional migratory chronic ulcerative colitis.” As in diffuse ulcerative colitis, it was noted that a short segment of terminal ileum in continuity with the diseased colon could be involved by “backwash ileitis.” In 1938 Crohn and Berg (3) reported a similar group of cases under the name of “right-sided regional colitis.” These investigators preferred to stress the localization in the right side of the colon. They considered the process, however, to be a form of diffuse ulcerative colitis. Neuman and Dockerty (4) in 1954 described the pathologic alterations, employing the term “regional colitis,” and noted involvement of the distal ileum in 25 per cent of their cases.