A case of indeterminate colitis undergoing subtotal colectomy

The nomenclature inflammatory bowel disease (IBD) generally defines ulcerative colitis (UC) and Crohn's disease (CD). However, we sometimes find patients who cannot be diagnosed as UC or CD, because of the presence of both characteristics. These cases have been reported as indeterminate colitis (IC) since the first report in 1978. In our department, we have experienced IBD since 1993 (366 cases of CD), but only three cases were diagnosed as IC. Of the three, we report here the clinical and pathological features of a patient who was followed up since the diagnosis. The case was a 19-year-old Japanese woman without any particular past history. In December 1997, she was admitted to our hospital complaining of abdominal pain, high fever, diarrhea and fresh blood in the stool. Based on the findings of various tests, we made a diagnosis of IC, and started to treat her with prednisolone intravenous injection (i.v) at a dose of 40 mg per day. Because symptoms and signs of inflammation relapsed frequently, it was judged that there was a relative indication for surgical operation. She underwent subtotal colectomy with end-to-end ileorectal anastomosis on 6 January 2002. On the histopathological examination of surgical specimens, several characteristics of both UC and CD were observed. Therefore, we finally diagnosed this case as IC. After operation, she has not experienced a relapse so far and maintained fair physical condition.