Caecal ulceration in an asymptomatic man

A 66-year-old Caucasian man underwent bowel cancer screening colonoscopy. He was asymptomatic with no significant medical history and no family history of bowel cancer or IBD. Clinical examination was normal and routine blood tests including haematinics, renal function, electrolytes and liver function were normal. Colonoscopy revealed several shallow periappendiceal caecal ulcers (figure 1). CT revealed caecal thickening with a few small para-caecal lymph nodes. The liver, spleen, small intestine and remaining colon were normal (figure 2). Biopsies from the ulcer demonstrated acute inflammatory changes with a dense infiltrate of lymphocytes, plasma cells and neutrophils in the lamina propria. There was no dysplasia, crypt abscesses or granulomas and mycobacterium cultures were negative. Biopsies from the terminal ileum were normal. Question What are the possible diagnoses? What is the next step in managing this patient? Answer Caecal ulcers can occur in the setting of...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research