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The term focal active colitis (FAC) is conventionally used to describe the presence of isolated cryptitis, characterized by an inflammatory infiltrate consisting of intraepithelial neutrophils and/or neutrophils invading the lumen of the criptae, with no other microscopic alteration of the colonic mucosa and, in particular, without the presence of signs of chronic inflammation. To date, only four studies, including one conducted in a pediatric population, have been performed to evaluate the clinical significance of this disease. The aim of this retrospective study on prospectively-collected data is to evaluate the clinical implications of the focal active colitis, since there still remains a marked uncertainty regarding this topic and about how often such a diagnosis will presage a diagnosis of inflammatory bowel disease (IBD). Clinical, endoscopic, and pathological data were retrospectively reviewed from 30 patients with focal active colitis, who had no other diagnostic findings on colorectal biopsy and no history of chronic inflammatory bowel disease. The histological findings were correlated with clinical diagnoses. Thirty patients (11 males, 19 females; age 24-80 years, median 56 years) (0.5%) out of 5,600 undergoing colonoscopy between January 2012 and December 2016 presented a definitive diagnosis of FAC. Follow-up ranged from 6 to 60 months (median 24 months). At endoscopy, 19 patients (63%) had mild and non-specific changes, such as mild mucosal erythema, while 11 (37%) had normal findings. Eight patients were documented as having irritable bowel syndrome, while nine cases could be attributed to the effects of drugs, five presented FAC as incidental finding, one a diagnosis of infectious colitis, and seven a diagnosis of IBD (4 with Crohn’s disease). FAC was confirmed to be a more significant predictor of IBD than the previous literature would indicate, even if larger prospective studies, targeted to study this relationship, are needed to understand more clearly its clinical significance.

Introduction: Inflammatory bowel diseases are heterogeneous in their presentation. Crohn's disease (CD) has been described as an unusual cause of massive lower gastrointestinal bleeding. We present a patient with CD whose first presentation was hemoperitoneum following mild blunt abdominal trauma Case presentation: A 54-year-old woman came to the emergency room with a blunt abdominal trauma. The patient underwent an abdominal CT scan with i.v. contrast medium injection, which showed hemoperitoneum with stenotic strictures of the small bowel and active massive bleeding from ileocolic artery. The rapid anemia onset and the CT report induced us to perform blood transfusion and an emergency exploratory laparotomy. Histological examination of the resected terminal ileum revealed a Crohn's disease. Discussion: Crohn's disease has been associated with hemoperitoneum, but to date there is no exact protocol regarding treatment of massive hemorrhagic Crohn's disease, which is rare. A conservative approach with medical therapy has been suggested for initial treatment. However, if medical treatment fails or bleeding continues even with intervention, bowel resection through surgical therapy should be performed.

Presentiamo la nostra esperienza riguardo la progettazione e l'utilizzo di un plug-in per il software open-source di visualizzazione di immagini DICOM (OsiriX 32-bit; GNU General Public License) per la valutazione dei criteri dimensionali e densitometrici di metastasi epatiche in TCMS.