First endoscopic appearance of ulcerative colitis.

We would like to report on a case that could represent the first endoscopic presentation of ulcerative colitis as a focal colitis of some isolated colonic folds. A 46year old asymptomatic male underwent a surveillance endoscopy for adenomatous polyps in the past. In the sigmoid part of the colon one sessile adenomatous polyp of 6mm was removed by snare polypectomy. Surprisingly endoscopy revealed focal abnormalities on four colonic folds. Two of these folds were situated in the transverse colon and two in the sigmoid part of the colon. A third of the circumference of these four folds showed inflammation with edema and granularity of the mucosa (Fig. 1). The ileum and rectum were completely normal. Histology of biopsies showed diffuse infiltration of inflammatory cells in the lamina propria and crypt abscesses. Since the patient was asymptomatic, no treatment was initiated. He was instructed to contact the outdoor department if he noticed any changes in bowel habits. One month later he presented with frequent stools and blood loss. Stool cultures were negative for bacteria and parasites. Repeated endoscopy showed contiguous and circumferential inflammation (loss of mucosal vascular pattern, hyperaemia, oedema and granular mucosa) from rectum to hepatic flexure (Fig. 2). The terminal ileum and