Anorectal lesions associated with granulomatous colitis

Summary and Conclusions Three cases of primary granulomatous colitis and one of ileocolitis are presented in which the initial symptoms were of anal origin. Inflammatory disease of the bowel was suspected on account of unusual anorectal lesions. The diagnosis of granulomatous colitis was established by correlation of clinical and roentgenologic findings, aided, on occasion, by histologic examination. X-ray of the small bowel and colon is mandatory in the presence of indolent anorectal disease. Roentgenologic interpretation of a localized lesion of the colon in the presence of indolent anorectal disease should be tempered by clinical findings and biopsy. An anorectal lesion manifesting the characteristic features of granulomatous disease should be considered in the same light as a skip area. In the past, many of these lesions have been regarded as either tuberculous or ordinary suppurative disease. The presence of such a lesion is an important aid in the diagnosis of granulomatous colitis. Injudicious anorectal and colon surgery may be avoided when underlying granulomatous disease is discovered.