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Investigation of Colonic and Rectal Disease [Abridged]

Ulcerative colitis usually starts distally in the pelvic colon and rectum and extends proximally in a continuous manner. Crohn's disease tends to start in the proximal colon and extend distally in a patchy manner with intervening normal areas. The ulcers in ulcerative colitis commonly are of the collar-stud type, giving the colon a double contour, whereas the ulcers in the Crohn's disease tend to be deep and fissure-like. Toxic dilatation, pseudopolypi, and adenomatous polypi and malignant tumours are all more common in ulcerative colitis than in Crohn's disease. In a number of cases, however, the differentiation on radiological grounds is impossible. Pneumatosis coli, ischiemic colitis, tuberculosis, amebiasis, irradiation colitis and an irritable spastic colon must be considered in the differential diagnosis of both Crohn's disease and ulcerative colitis.