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The isolated caecal patch lesion: a clinical, endoscopic and histopathological study
  1. Anju Ekanayaka1,
  2. John T Anderson2,
  3. Michele E Lucarotti3,
  4. Roland M Valori4,
  5. Neil A Shepherd1
  1. 1Gloucestershire Cellular Pathology Laboratory, Cheltenham, UK
  2. 2Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
  3. 3Department of Colorectal Surgery, Gloucestershire Royal Hospital, Gloucester, UK
  4. 4Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
  1. Correspondence to Professor Neil A Shepherd, Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucester GL53 7AN, UK; neil.a.shepherd{at}nhs.net

Abstract

Objective To describe and investigate the potential causes of the isolated caecal patch lesion, a previously undescribed endoscopic phenomenon of a lesion fulfilling endoscopic and histopathological criteria for chronic inflammatory bowel disease but without evidence of similar inflammatory pathology elsewhere at colonoscopy.

Methods Cases were collected prospectively by one specialist gastrointestinal pathologist over a 10-year period. Full endoscopic and histopathological analysis was undertaken and follow-up sought to understand the likely cause(s) of the lesions.

Results Six cases are described. Two had very close links with ulcerative colitis, one predating the onset of classical distal disease and the other occurring after previous demonstration of classical distal ulcerative colitis. Two occurred in younger patients and we postulate that these lesions may predict the subsequent onset of chronic inflammatory bowel disease. Finally two can be reasonably attributed to the effects of non-steroidal inflammatory agent therapy.

Conclusions Caecal patch lesions can be demonstrated in isolation. Despite the strong association of caecal patch lesions with ulcerative colitis, solitary lesions may well have disparate causes but nevertheless possess a close relationship with chronic inflammatory bowel disease.

  • inflammatory bowel disease
  • intestine
  • colon
  • gastrointestinal disease
  • histopathology
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Footnotes

  • Handling editor Dhirendra Govender.

  • Contributors NAS collected the initial data. AE collected and organised the data on the pathological findings and AE and NAS assessed the pathology equally and contributed to the writing and editing of the manuscript equally. JTA, MEL and RMV all contributed equally to the collection and organisation of clinical and endoscopic data and the writing and editing of the manuscript. JTA provided the endoscopic photographs.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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