Interpret
Reading File
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Finding Sources
I now have enough information from the textbooks to give a thorough interpretation. Here is the full analysis:
Colonoscopy Report Interpretation
Patient: Shafeeq, 38-year-old male
Date: 25 June 2026
Performed by: Dr. Satheesh Balakrishnan, MD DM (Gastroenterology)
Institution: The Thaliparamba Co-op Hospital Society Ltd., Department of Gastroenterology
Why the Scope Was Done
The procedure was performed for bleeding and mucous per rectum - the classic presentation of colorectal mucosal inflammation. No premedication was required and bowel preparation was adequate.
Segment-by-Segment Findings
| Segment | Finding |
|---|---|
| Anal Canal | Haemorrhoids |
| Rectum | Loss of vascularity, granularity, friability |
| Sigmoid Colon | Loss of vascularity, granularity, friability |
| Descending Colon | Loss of vascularity, granularity, friability |
| Splenic Flexure | Loss of vascularity, granularity, friability |
| Transverse Colon | Loss of vascularity, granularity, friability |
| Hepatic Flexure | Normal |
| Ascending Colon | Normal |
| Caecum | Normal |
| IC Valve | Normal |
| Ileum | Normal up to 10 cm of terminal ileum |
What the Endoscopic Signs Mean
These three findings - loss of vascularity, granularity, and friability - are the classic triad of active ulcerative colitis (UC):
- Loss of vascularity: Normally the submucosal blood vessels are visible through the colonic mucosa as a branching pattern. When mucosal inflammation and edema develop, this pattern is obliterated. It is one of the earliest signs of UC.
- Granularity: The normally smooth mucosa takes on a fine or coarse granular texture, representing microscopic or pinpoint ulcerations. Coarse granularity is associated with friability.
- Friability: The inflamed mucosa bleeds easily on contact with the scope - this "contact bleeding" reflects severe mucosal fragility. It is a hallmark of active UC and directly explains this patient's rectal bleeding.
As described in Goldman-Cecil Medicine: "Early in the disease process, patients develop diffuse mucosal erythema with loss of the normal mucosal vascular pattern. In mild disease, the mucosa may have a granular and edematous appearance. As the disease becomes more severe, the mucosa becomes more friable, bleeds easily when the mucosa is touched, and may eventually ulcerate."
Distribution - Clinically Significant
The disease involves rectum → sigmoid → descending colon → splenic flexure → transverse colon, with the hepatic flexure, ascending colon, and caecum being completely normal. The terminal ileum is also normal.
This is a continuous, uninterrupted lesion starting from the rectum and extending proximally - which is the defining distribution of UC. In UC:
- Disease always starts in the rectum (rectal sparing would instead suggest Crohn's or other diagnoses)
- It extends proximally in a continuous (not patchy/skip) pattern
- It is confined to the colon; small bowel is spared (hence the normal terminal ileum here)
Based on extent, this patient has left-sided (extensive) colitis, extending from the rectum to the transverse colon - i.e., beyond the splenic flexure. This is classified as E3 (extensive colitis) per the Montreal Classification.
The terminal ileal normality rules out Crohn's ileocolitis and "backwash ileitis" (the latter being a mild spillover sometimes seen in pancolitis UC).
Haemorrhoids
The anal canal shows haemorrhoids - these are common, likely contributing to bleeding and mucous discharge. However, in the context of extensive colitis, they are a secondary finding and not the primary diagnosis.
Impression (as stated in the report)
Colitis. Biopsy taken to rule out Ulcerative Colitis. Haemorrhoids.
The endoscopist is correct to take biopsies - UC is a histological diagnosis and the biopsy is required to:
- Confirm UC - crypt distortion, crypt abscesses, basal plasmacytosis
- Rule out infectious colitis (e.g., CMV, C. difficile, amoeba, which can mimic UC endoscopically)
- Rule out Crohn's colitis - presence of granulomas would suggest Crohn's
Key Differentials to Exclude with Biopsy
| Diagnosis | Distinguishing Feature |
|---|---|
| Ulcerative colitis | Continuous from rectum, crypt distortion, no granulomas, no small bowel involvement |
| Crohn's colitis | Skip lesions, transmural inflammation, granulomas, possible terminal ileal involvement |
| Infectious colitis (e.g., amoebiasis, C. difficile) | Acute crypt architecture preserved, relevant culture/serology |
| Ischaemic colitis | Typically splenic flexure watershed distribution, not rectal |
What Comes Next
Given these findings, the treating gastroenterologist will likely:
- Await biopsy results to confirm UC and exclude infectious mimics
- Assess disease severity (mild/moderate/severe) clinically (stool frequency, rectal bleeding, pulse, haemoglobin, ESR - Mayo/Truelove-Witts scoring)
- Initiate or optimize 5-ASA therapy (e.g., mesalazine oral + rectal for left-sided disease)
- Consider topical steroids if active flare
- Monitor for complications: toxic megacolon, perforation, dysplasia (with long-term surveillance colonoscopy after 8-10 years of disease)
Bottom line: This colonoscopy strongly points to active left-sided ulcerative colitis (E3, Montreal classification), with the characteristic continuous mucosal inflammation from rectum to transverse colon, sparing the right colon and terminal ileum. The biopsy is the definitive next step to confirm the diagnosis and guide treatment.
- Goldman-Cecil Medicine, pp. 1481-1483
- Rosen's Emergency Medicine, p. 2747
This is a shared conversation. Sign in to Orris to start your own chat.