Introduction

Indeterminate colitis (IC) is a definition first proposed by Kent in 1970 [1] for some features of both ulcerative colitis (UC) and Crohn's Disease (CD) found in patients' colonic surgical specimen. Some years later, Morson [2] proposed the term "unclassified colitis", describing surgical specimen of patients operated for acute fulminant colitis with suspicion of CD or UC but equivocal pathology. Thus, originally, the term IC was a pure histopathologic diagnosis. It would still probably represent a strictly academic argument if total proctocolectomy with ileal pouchanal anastomosis (IPAA) did not obtain such a wide popularity for the treatment of UC.

The need for preoperative differential diagnosis between UC and CD is essential to the surgeon since different surgical procedures are indicated in the two entities. In fact, patients with CD submitted to IPAA appear to have a significantly higher rate of pouch failure and long-term complications than those with UC. In recent years, the term IC has become a clini-copathologic diagnosis, and it has been applied to include all those cases with endoscopic, radiographic and histologic signs of inflammatory bowel disease (IBD) confined to the colon but "without fulfillment of diagnostic criteria for UC and CD" [3]. Many reports show how, despite many clinical investigations performed by expert teams, a considerable rate of IC patients continue to be classified as IC after long-term follow-up [4-7]. It is still not clear, then, whether IC is only a temporary diagnosis, a kind of "colitis in evolution" [8], or represents itself a disease entity.

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