Spectrum of acute self-limiting colitis: role of the clinician and pathologist

Acute self-limited colitis encompasses several diagnostic possibilities such as infectious colitis, post-antibiotic colitis, drug-induced colitis and should be differentiated from acute forms of inflammatory bowel disease. Diverticular disease in the elderly patient with colonic ischaemia may also give symptoms of acute bloody mucoid rectal discharge and should be recognised, although the clinical picture is usually completely different. Recognition of the causative agent--if possible--is particularly important in the patient with a foudroyant colitis (e.g. toxic megacolon), when the clinician has to decide, whether antibiotics or corticosteroids should be given or even a resection should be performed. A short history usually indicates towards infection, but a long-standing history of inflammatory bowel disease may be complicated by a superinfection. Faecal cultures, endoscopy with colonic biopsy should be performed and results be discussed. New techniques for the assessment and follow up of difficult cases are: white cell scintigraphy, computerized tomography scanning and magnetic resonance imaging scanning. Acute self-limited colitis can usually be classified properly and treated accordingly. This review discusses the role to be played by the clinician, microbiologist and pathologist and is illustrated by several clinical examples, in which patients presented with unusual forms of acute self-limited colitis.