In ileocolic resection for suspected CD, should the pathology report include assessment of skip lesions and transmural inflammation severity to guide postoperative therapy

What is known

- Practice guidance recommends recording macroscopic transmural extension and fistulas, and sampling both affected and macroscopically normal mucosa to improve diagnostic yield. ¹ - In Crohn's, diseased segments are frequently separated by normal bowel (skip lesions) with abrupt transitions, a recognized diagnostic feature. ¹ - Transmural inflammation and fissure ulceration, usually reliable Crohn's indicators, may occur in fulminant colitis of any cause; granulomas and transmural lymphoid aggregates are more specific. ² - A study subgrouping indeterminate colitis by features including deep ulcers, transmural lymphoid aggregates, and skip lesions found these may predict complications but not late pouch failure. ³

What is unknown / caveats

- Transmural inflammation, usually a reliable Crohn's indicator, can also occur in fulminant colitis of any cause and should not by itself deter a UC diagnosis ² - Retrieved excerpts address diagnosis/classification and pouch outcomes, not selection of postoperative medical therapy after ileocolic resection - No excerpt links skip lesions or transmural severity grading to a specific postoperative treatment decision - Diagnosis of Crohn's/indeterminate colitis is described as clinicopathologic, requiring clinical and radiologic correlation, not histology alone ⁴ - The evidence supports these features' diagnostic value but does not establish that reporting them guides postoperative therapy choice.

## References

1. Langner C, Magro F, Driessen A, Ensari A, Mantzaris GJ, Villanacci V, Becheanu G, Borralho Nunes P, Cathomas G, Fries W, Jouret-Mourin A, Mescoli C, de Petris G, Rubio CA, Shepherd NA, Vieth M, Eliakim R, Geboes K, European Society of P, European Crohn's and Colitis F. The histopathological approach to inflammatory bowel disease: a practice guide. Virchows Arch. 2014;464(5):511-27. PMID: 24487791.

2. Swan NC, Geoghegan JG, O'Donoghue DP, Hyland JM, Sheahan K. Fulminant colitis in inflammatory bowel disease: detailed pathologic and clinical analysis. Dis Colon Rectum. 1998;41(12):1511-5. PMID: 9860331.

3. Gramlich T, Delaney CP, Lynch AC, Remzi FH, Fazio VW. Pathological subgroups may predict complications but not late failure after ileal pouch-anal anastomosis for indeterminate colitis. Colorectal Dis. 2003;5(4):315-9. PMID: 12814408.

4. Wolff BG. Is ileoanal the proper operation for indeterminate colitis: the case for. Inflamm Bowel Dis. 2002;8(5):362-5; discussion 368-9. PMID: 12479652.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._