Indeterminate Colitis

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Indeterminate colitis is an exclusion diagnosis that is used for 10–15 % of patients who have had a colectomy for inflammatory bowel disease (IBD)–related colitis when there are no definite features of ulcerative colitis or Crohn’s colitis. The term is reserved for operated patients; those still not operated on and in whom the diagnosis is an uncertain are now considered to be 'IBD unclassified'. The specific diagnosis given to a patient with IBD colitis depends on the clinical course and features, the endoscopic appearance, and to a large extent the microscopic findings, though it is evident that there is room for judgment and uncertainty. Over time, many patients with an indeterminate colitis will be reconsidered and labeled with a definite diagnosis, often ulcerative colitis. With the advent of restorative proctocolectomy including a pelvic pouch, this diagnostic dilemma has become more important. Most surgeons will not recommend a pelvic pouch to a patient with a definite diagnosis of Crohn’s disease, since most studies report a higher risk of pelvic septic complications and pouch failure in these patients. However, most agree that the risk in a patient with an indeterminate colitis is considerably less, with an only a slightly increased complication rate, compared with those with an ulcerative colitis.