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The Old Endoscopy Quiz (and Answer) of the Month
June 2007

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Question:

Click on the image above to start the slide show!

This young lady came to a colonoscopy as she hade suffered from a mild diarrhea for a couple of years. Her laboratory investigations were quite normal. The colonoscopy was performed after a bowel cleaning with Phosphoral (TM). These images show the findings in her rectum. The colon was completely normal. What is this potentially quite dangerous finding? And what is the dangerous thing about it? (You don´t have to answer the second question if You don´t wish to).

Correct answer:

Small Aphtoid Lesions Caused by Bowel Preparation. The danger with this innocent finding is that it can resemble aphthoid ulcers seen in Crohn´s disease, perhaps causing an incorrect diagnosis.

Small aphthoid ulcers due to colonoscopy preparation

Preparation induced colitis Cleaning of the colon with a sodium phosphate preparation can cause slight mucosal lesions, mostly small aphthoid ulcers with a surrounding erythema. The finding can resemble aphthoid ulcers seen in Crohn´s disease. Biopsies reveal mild acute inflammation. (Image contributed by MD Phillip Lerner, FL, USA)

Correct answers and comments were emailed by

Virendra Parikh,MD, Fort Wayne, USA, Indiana
BURHAN TAM, Silivri-İSTANBUL, TÜRKİYE
Sharon Hauckwitz, Mooretown, Canada
NALAN TAŞIN, Silivri-İSTANBUL, TÜRKİYE
U Cuartas, Augusta, USA
GÜL ADIKALAN, İSTANBUL, TÜRKİYE
yusuf yücel, karabük, Turkiye
BURHAN TAM, Silivri-İSTANBUL, TÜRKİYE
Salvatore Della Ducata, Gallipoli, Italy
Dr.ARBER Veliu, Prishtina, Kosova.
Trinh Albert Truong, Los Angeles, CA, USA
luisguillermoguerrero, Bogota, Colombia
Roderick Mcdaniel, Tuscaloosa, Alabama
Samyra David, Montes Claros, Brasil -MG
Ervin Toth, Malmoe, Sweden
Zahreddine Radwan, Beirut, Lebanon
Vitor Fernandes, Almada, Portugal
Dr Sheikh Anwar Abdullah, Kuala Lumpur, Malaysia
Cevale Karslioglu Sgouros, Istanbul, Turkey
HALLIE HART, NORTH BAY, CANADA
BULUT BANAZILI, Silivri-İSTANBUL, TÜRKİYE
MEHMET, POLAT, ANKARA
Cheryl Lynch, Erie, USA/PA
Ayyakannu Kumar, Brentwood, Essex, United Kingdom
Altin CEKODHIMA, Tirana, ALBANIA
Bee Lee, Belfast, United Kingdom
Tassos Koulaouzidis, Llandudno, North Wales
KLAUDIA J.Niepsuj, Gliwice, Poland
Mohsin, Glasgow, UK
Zuhair Homsi, Dammam, Saudi Arabia
Abdon Guerra, San Antonio, 5 region, Chile
Fernando Peres, Rio de Janeiro, Brazil

Comments:

Mucosal lesions;small aphthoid lesions with erythema induced by sodium phosphate preparation.Not have clinical significance.
Sodium phosphate induced proctitis - can be mistaken for aphthoid ulcers in Crohn's disease
Aphtous ersosion caused by Phosphoral preparation and mimicking Crohns lesions.
Aphthoid ulcers with a surrounding erythema due to a bowel cleaning with Phosphoral.
1. These are 'bowel prep' induced aphthous ulcers.2. They can be wrongly mistaken as ulcers caused by inflammatory bowel disease (such as Crohn's), when actually they are quite harmless and resolve quickly (after having stopped the bowel prep).
Surprised i haven't used this site before. Well done its great
O uso de fosfato de sódio via oral pode provocar o aparecimento de lesões aftóides em mucosa, podendo confundir com o achado de doença inflamatória intestinal. Por isso, o fosfato de sódio não pode ser usado no preparo do cólon desses pacientes.

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