ENDOSCOPIC STUDY IN THE ACUTE STAGE OF ISCHEMIC COLITIS

Abstract

Ischemic colitis was morphologically classified into circular, longitudinal, transverse and macular lesions on the basis of endoscopic findings in the acute stage of the disease. Longitudinal lesions were seen most frequently. When endoscopic findings were divided qualitatively into vasodilation, scale-pattern, pseudomembranelike appearance and cyanotic appearance, the scale-pattern was most frequent. When these qualitative endoscopic features were compared with pathological findings, the severity of ischemia evaluated pathologically increased in the order of vasodilation, scale-pattern, pseudomembranelike appearance, and cyanotic appearance. This endorsed the validity of the qualitative endoscopic classification. When observed at higher magnifications, the scale-pattern was found to be composed of white innominate sulcus discernible from small reddish segments representing intramucous bleeding. These results suggest that the most typical endoscopic feature of ischemic colitis in its acute stage is the major lesion showing longitudinal pseudomembranelike appearance and surrounding scale-patterns, accompanied by minor lesions such as scale-patterned transverse lesions or macular lesions.