The diagnosis of ulcerative colitis may be challenging under certain circumstances.


Conditions which can make the diagnosis of ulcerative colitis challenging:

(1) presence of a superimposed colitis

(2) inadequate or misleading information

(3) fulminant disease


Conditions where some findings may be lacking:

(1) following therapy

(2) low grade disease in remission

(3) initial presentation in a pediatric patient


Situations which may cause confusion with Crohn’s disease:

(1) presence of backwash ileitis

(2) appendiceal involvement

(3) false impression of skip lesion when there is cecal and/or ascending colon involvement

(4) involvement of the duodenum or other upper gastrointestinal site

(5) relative sparing of rectum

(6) granuloma associated with rupture of a crypt abscess

(7) presence of a superficial fissure


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