The “cecal patch” in patients with ulcerative colitis
Kleanthis Dendrinos MDa, Sandra Cerda MDb and Francis A. Farraye MD, MSca
aSection of Gastroenterology, Boston University Medical Center, Boston, Massachusetts, USA
bDepartment of Pathology, Boston University Medical Center, Boston, Massachusetts, USA
Available online 11 July 2008.
CommentaryUC is a disease that classically begins just inside the squamocolumnar junction of the anorectum and extends proximally for a variable distance in a circumferential and uniform fashion, without “skip” areas. There are 2 types of segmental inflammatory change, however, that may be seen in patients with UC, and that may lead to confusion with Crohn's disease: backwash ileitis and the cecal patch; neither affects the course of the colitis. Patients with UC with backwash ileitis usually have involvement of the cecum and pancolitis, but may have only left-sided disease. An isolated cecal patch of inflammation, as in the present case, is present in many patients with left-sided UC or proctitis/proctosigmoiditis. We have learned that cecal inflammation may be part of normal cecal health, and that the cecum has a higher percentage of eosinophils, Paneth cells, and laminar propria inflammation than do other areas of the colon. The important lesson: don't diagnose Crohn's disease just because you see a patch of cecal inflammation in a patient with distal colitis. Pythagoras believed he could judge the height of Hercules from the length of his foot (ex pede Herculem), and from this it was extrapolated that from a sample one can judge the whole. This adage certainly is not evidence-based, and should not be used to rationalize judgment of the nature of colitis from the presence of a cecal patch