Colorectal cancer differential diagnosis

To view the differential diagnosis of familial adenomatous polyposis (FAP), click here
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief:  Trusha Tank, M.D.[2],  Qurrat-ul-ain Abid, M.D.[3]

## Overview[edit | edit source]

Colorectal cancer must be differentiated from other diseases that cause unexplained weight loss, unexplained loss of appetite, nausea, vomiting, diarrhea, anemia, jaundice, and fatigue, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease. There are less common conditions that may be confused as colorectal cancer such as infectious colitis and gastrointestinal lymphoma.

## Colorectal Cancer Differential Diagnosis[edit | edit source]

* Colorectal cancer must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, diverticulitis, inflammatory bowel disease, cystitis, and endometritis.[1][2][3][4][5][6]

Other conditions that can be mistaken for colorectal cancer include the following:

* Benign colon polyps
* Infectious colitis
* Arteriovenous malformation (AVM)
* Carcinoid/neuroendocrine tumors
* Small intestine carcinomas
* Gastrointestinal lymphoma
* Pregnancy
* Appendicitis
* Hernia
* Lactose intolerance
* Flatulence
* Ulcer
* Cholecystitis

ABBREVIATIONS:N/A: Not available , N/V: Nausea/vomiting, M/C: Most common, DRE: Digital rectal exam, RLQ: Right lower quadrant, LLQ: Left lower quadrant

Diseases  | Clinical manifestations | Para-clinical findings  | Gold standard
Symptoms
Lab Findings  | Imaging  | Histopathology
Bowel frequency  | Blood in stool  | Abdominal pain  | Tenesmus  | Other symptoms  | Anemia  | Colonoscopy  | CT scan  | Other diagnostic study
Colorectal carcinoma (Adenocarcinoma)[7] | ↑ or ↓  | \+  | +/-  | \+  |

* Weight loss
* Fatigue
* Low caliber of stools
* Mucus in stools

| \+  |

* Polyps (villous, tubular, tubulo-villous)
* Ulcerating polyps
* Cancerous lesions

* Luminal narrowing
* Bowel obstruction
* Thickening of the bowel wall
* Lymphadenopathy
* Metastases

| PET scans

* Metastasis

Barium enema

* Cancer or precancerous polyp

* Different grades of differentiation of glandular structures
* Sheets or cords of malignant cells
* Cellular atypia and pleomorphism
* High mitotic rate
* Necrotic debris in glandular lumina
* Desmoplastic reaction (sign of invasion)

| Biopsy, genetic testing, and histopathological analysis
Peutz-Jeghers syndrome
[8][9][10][11][12] | ↑ or ↓  | \+  | \+  | \-  |

* Weight loss
* Fatigue
* Mucocutaneous hyperpigmentation
* Rectal prolapse

| \+  |

* Multiple polyps
* Mucocutaneous pigmentation

* Multiple polyps
* Intussusception
* Bowel obstruction

| Barium enema

* Multiple polyps

MRI

* Multiple hamartomatous polyps

* Hamartomatous mucosal polyps with core of smooth muscle associated with mucosa
* Smaller polyps lack the prominent arborizing smooth muscle

| Genetic testing for STK11 and colonoscopy
Carcinoids
[13][14][15][16][17] | ↑  | +/-  | \+  | \-  |

* Weight loss
* Weakness
* Flushing
* Wheezing
* Shortness of breath
* Palpitations
* Leg edema

| \+  |

* Infiltrating, ulcerating or fungating lesions in the wall of colon

* Well-defined single/multiple lesions
* Round/ovoid in shape
* Variable in size between 2-5 cm

| PET scan (11C-5-hydroxytryptophan, 11C-5-HTP)

* Detects metastasis

MRI

* Nodular mass
* Wall thickening
* Metastasis

Ki-67 index

* Solid/spongy nests of cells accentuated by neatly outlined luminal spaces

* Peripheral nuclear palisading
* Granular eosinophilic cytoplasm

| Biopsy and histopathological analysis
Diseases  | Bowel frequency  | Blood in stool  | Abdominal pain  | Tenesmus  | Other symptoms  | Anemia  | Colonoscopy  | CT scan  | Other diagnostic study  | Histopathology  | Gold standard
Juvenile Polyposis Coli[18][19][20][21][22] | ↑  | \+  | \+  | \-  |

* Prolapsing polyp
* Intussusception
* Macrocephalus
* Hypotonia
* Bowel obstruction
* Heart or brain abnormalities
* Cleft palate
* Polydactyly
* Genitalia or urinary abnormalities

| \+  |

* >5 juvenile polyps in the colon and rectum
* Multiple juvenile polyps in gastrointestinal tract

* Multiple polyps in GI tract

| Barium study

* Multiple polyps in GI tract

Stool DNA test

* SMAD4 or BMPR1A

Diagnose if any of the following positive:

* More than five juvenile polyps of the colorectum
* Multiple juvenile polyps throughout the GI tract
* Any number of juvenile polyps and a family history of juvenile polyposis
* Heterozygous pathogenic variant in SMAD4 or BMPR1A

* Cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
* Lamina propria edematous with associated lymphocytes, plasma cells, eosinophils, and neutrophils
* Filiform, multilobed forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps
* Areas of conventional dysplasia

| Diagnostic criteria fulfilment
Gastrointestinal Stromal Tumors (GIST)[23][24][25][26][27] | \-  | +/-  | \-  | \-  |

* Asymptomatic
* Early satiety
* Bloating

| +/-  |

* Subepithelial round masses
* Smooth margins
* Normal overlying mucosa may be intact or ulcerated
* Bulging into gastrointestinal lumen

| Benign

* Small, < 10 cms
* Homogeneous
* Clear boundaries
* intraluminal or extraluminal growth

Malignant GIST with metastasis:

* Size > 10 cm
* Calcifications
* Irregular margins
* Heterogeneous and lobulated
* Lymphadenopathy
* Ulceration
* Extraluminal and mesenteric fat infiltration

Endoscopic ultrasonography

Benign:

* Mucosal ulceration or bleeding
* Smooth submucosal mass as hypoechoic mass

Malignant GIST:

* Heterogeneous mass >4 cm in size
* Irregular borders
* Intra/extraluminal growth
* Multiple cysts

* Spindle cell type are eosinophilic cells arranged in the form of whorls or fascicles[28][29]
* Epithelioid GISTs are rounded cells with oval nuclei and vesicular chromatin and appears nested
* On immunohistochemical staining they are positive for molecular markers CD117 antigen and KIT protein

| Endoscopic ultrasound

biopsy and histopathological analysis

Hamartoma[30] | ↑ | \+  | \+  | \+  |

* N/A

| \-  |

* Large polypoid mass

* Isodense/hypodense solid masses
* Heterogeneous mass
* Presence of fat
* Calcification

| Biopsy

* Proliferation of bland spindle cells in the lamina propria
* Mucosal Schwann cell hamartoma (MSCH)

* Poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts
* The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct
* Involvement of mucosa but never the submucosa

| Biopsy
Diseases  | Bowel frequency  | Blood in stool  | Abdominal pain  | Tenesmus  | Other symptoms  | Anemia  | Colonoscopy  | CT scan  | Other diagnostic study  | Histopathology  | Gold standard
Colorectal Lymphoma[31][32] | \-  | +/-  | \+  | \-  |

* Weight loss

| \+  |

* Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions

* Polypoid mass
* Circumferential-cavitary lesions
* Focal mucosal nodularity
* Diffuse ulcerative or nodular lesions
* Lymphadenopathy

| Double-contrast enema

* Subtle mucosal changes
* Gross tumor morphology

Biopsy

* Diffuse large B-cell lymphoma:
* Extranodal marginal zone lymphoma (MALT)
* Mantle cell lymphoma
* Burkitt’s lymphoma
* Follicular lymphoma

| Biopsy
Kaposi's sarcoma[33] | ↑ | \+  | \+  | \-  |

* Nausea and vomiting

| \+  |

* Localized purpuric lesion

* N/A

| Serology

* Antibodies against Kaposi sarcoma herpes virus (HHV-8)

Biopsy

* Vascular proliferation
* RBC and hemosiderin extravasation
* Lymphocytes and monocytes
* Premonitory sign (neovascular lesion wrapped around a pre-existing space)
* Intracytoplasmic PAS +ve hyaline globules

| Biopsy
Arteriovenous malformation[34] | \-  | \+  | \-  | \-  |

* N/A

| \+  |

* Bright red, flat lesions
* Rarely, polypoid

* N/A

* N/A

* Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa
* Arteries directly connected to veins without capillary beds

| Accidental finding
Diseases  | Bowel frequency  | Blood in stool  | Abdominal pain  | Tenesmus  | Other symptoms  | Anemia  | Colonoscopy  | CT scan  | Other diagnostic study  | Histopathology  | Gold standard
Diverticular diseases[35][36][37] | ↑ or ↓  | +/-  | \+

RLQ

| \-  |

* Fever
* Chills
* N/V

| \-  |

* Not recommended

* Outpouchings of the colonic wall (diverticula)
* Inflamed diverticula
* Abscess formation
* Intraperitoneal free air (microperforation)

| Barium enema

* Circumferential narrowing
* Spiculated contour
* Tapered margins

* N/A

| CT scan
Hemorrhoids[38] | ↓ | \+  | \+  | \-  |

* Perianal Itching
* Pain with defecation
* Painful-hard lump in anus

| \+  | Anoscopy

* Protruding mass from the anus

* N/A

| DRE

* Palpable mass, tender if thrombosed

* N/A

| Clinical
Anal fissure[39] | \-  | \+  | \+  | \-  |

* Painful defecation
* Itching
* Irritation

| +/-  | Anoscopy

* Anal wall laceration

* N/A

* N/A

* N/A

| Clinical
Diseases  | Bowel frequency  | Blood in stool  | Abdominal pain  | Tenesmus  | Other symptoms  | Anemia  | Colonoscopy  | CT scan  | Other diagnostic study  | Histopathology  | Gold standard
Infectious colitis[40] | ↑ | \+  | \+  | \-  |

* Fever, chills
* N/V
* Bloating

| \-  |

* Patchy or diffuse erythematous mucosa
* Edema, hemorrhage, with or without ulcers of mucosa

* N/A

| Stool analysis

* Leukocytosis

Stool cultures

* N/A

| Stool culture
Ulcerative colitis[41]V  | ↑ | \+  | \+

LLQ

| \+  |

* Weight loss
* Diarrhea withmucus
* Urgency

| \+  |

* Continuous lesions
* Erythema (or redness of the mucosa) and friability of the mucosa
* Crypts, formation of residual mucosal tissue
* Pseudopolyps

* N/A

* N/A

* Mucosal and submucosal inflammation
* Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
* Distorted crypts
* Crypt abscess

| Endoscopic biopsy
Crohn's disease[41] | ↑ | \+  | \+

RLQ

| \+  |

* N/V
* Bowel obstruction
* Fever

| \+  |

* Discontinuous lesions
* Strictures
* Linear ulcerations

* N/A

* N/A

* Transmural pattern of inflammation
* Mucosal damage
* Focal infiltration of leukocytes into the epithelium
* Granulomas

| Endoscopic biopsy
Irritable bowel syndrome[42] | ↑ ↓  | \+  | \+  | \+  |

* Weight loss
* Straining
* Urgency
* Mucus passage
* Bloating

| \-  |

* Not recommended

* N/A

| Diagnosis of exclusion

* Fulfilment of Rome criteria

* N/A

| Clinical diagnosis (Rome criteria)
Diseases  | Bowel frequency  | Blood in stool  | Abdominal pain  | Tenesmus  | Other symptoms  | Anemia  | Colonoscopy  | CT scan  | Other diagnostic study  | Histopathology  | Gold standard
Appendicitis[43] | ↑ | \-  | \+

RLQ

| \-  |

* Pain starting periumbilical before localizing to the RLQ
* N/V
* Fever
* Chills
* Loss of appetite

| \-  |

* N/A

* Appendiceal wall thickening (≥ 3mm)
* Periappendiceal fat stranding
* Thick lateral conal fascia and mesoappendix
* Extraluminal fluid
* Phlegmon
* Abscess

Ultrasound

* Aperistaltic, noncompressible, dilated appendix (>6 mm)
* Appendicolith
* Echogenic prominent pericaecal fat
* Periappendiceal fluid collection

* N/A

| CT scan
Strangulated hernia | ↓  | \-  | \+

RLQ

| \-  |

* N/V
* Heaviness/dull discomfort in the groin, with straining, lifting, coughing, or exercising
* Weakness, heaviness, burning, or aching in the groin
* Swelling
* Fever

| \-  |

* N/A

* Defect in the abdominal wall muscles
* Bowel loops within the lesion
* Lateral crescent sign
* The hernia neck superolateral to the course of the inferior epigastric vessels

| Ultrasound:

* Hypoechoic mass suggesting dilated and edematous intestinal segment

* N/A

| Ultrasound
Bowel endometriosis[44] | ↑ or ↓  | \+  | \+

Pelvic

| \+  |

* Dyschezia

| \+  |

* N/A

* N/A

| Transvaginal ultrasound

* Heterogeneous, hypoechoic, spiculated mass

T1-weighted or fat-suppression T1-weighted MRIs

* Contrast enhanced mass
* Hyperintense hemorrhagic
* Hyperintense cavities

* N/A

| Transvaginal ultrasound
ABBREVIATIONS:N/A: Not available , N/V: Nausea/vomiting, M/C: Most common, DRE: Digital rectal exam, RLQ: Right lower quadrant, LLQ: Left lower quadrant

## References[edit | edit source]

1. ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.CS1 maint: Multiple names: authors list (link)
2. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
3. ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
4. ↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
5. ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
6. ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
7. ↑ Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994). "Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum". Oncology. 51 (1): 30–4. doi:10.1159/000227306. PMID 8265100.
8. ↑ Zhong ME, Niu BZ, Ji WY, Wu B (June 2016). "Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer". World J. Gastroenterol. 22 (22): 5293–6. doi:10.3748/wjg.v22.i22.5293. PMID 27298573.
9. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
10. ↑ Giardiello, F; Trimbath, J (2006). "Peutz-Jeghers Syndrome and Management Recommendations". Clinical Gastroenterology and Hepatology. 4 (4): 408–415. doi:10.1016/j.cgh.2005.11.005. ISSN 1542-3565.
11. ↑ Beggs, A. D.; Latchford, A. R.; Vasen, H. F. A.; Moslein, G.; Alonso, A.; Aretz, S.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Friedl, W.; Moller, P.; Hes, F. J.; Jarvinen, H.; Mecklin, J.-P.; Nagengast, F. M.; Parc, Y.; Phillips, R. K. S.; Hyer, W.; Ponz de Leon, M.; Renkonen-Sinisalo, L.; Sampson, J. R.; Stormorken, A.; Tejpar, S.; Thomas, H. J. W.; Wijnen, J. T.; Clark, S. K.; Hodgson, S. V. (2010). "Peutz-Jeghers syndrome: a systematic review and recommendations for management". Gut. 59 (7): 975–986. doi:10.1136/gut.2009.198499. ISSN 0017-5749.
12. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
13. ↑ Chung TP, Hunt SR (May 2006). "Carcinoid and neuroendocrine tumors of the colon and rectum". Clin Colon Rectal Surg. 19 (2): 45–8. doi:10.1055/s-2006-942343. PMC 2780103. PMID 20011309.
14. ↑ Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq
15. ↑ Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B (May 2012). "TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study". J. Natl. Cancer Inst. 104 (10): 764–77. doi:10.1093/jnci/djs208. PMID 22525418.
16. ↑ Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J (June 2017). "Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China". Chin J Cancer. 36 (1): 51. doi:10.1186/s40880-017-0218-3. PMC 5480192. PMID 28637502.
17. ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
18. ↑ Grotsky HW, Rickert RR, Smith WD, Newsome JF (March 1982). "Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred". Gastroenterology. 82 (3): 494–501. PMID 7054044.
19. ↑ Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ (November 2011). "Juvenile polyposis syndrome". World J. Gastroenterol. 17 (44): 4839–44. doi:10.3748/wjg.v17.i44.4839. PMC 3235625. PMID 22171123.
20. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
21. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
22. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
23. ↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
24. ↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
25. ↑ Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD (July 2004). "KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications". Am. J. Surg. Pathol. 28 (7): 889–94. PMID 15223958.
26. ↑ Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K (November 2005). "18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors". World J Surg. 29 (11): 1429–35. doi:10.1007/s00268-005-0045-6. PMID 16222452.
27. ↑ Miettinen M, Sobin LH, Lasota J (January 2005). "Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up". Am. J. Surg. Pathol. 29 (1): 52–68. PMID 15613856.
28. ↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
29. ↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
30. ↑ Cauchin E, Touchefeu Y, Matysiak-Budnik T (September 2015). "Hamartomatous Tumors in the Gastrointestinal Tract". Gastrointest Tumors. 2 (2): 65–74. doi:10.1159/000437175. PMC 4668787. PMID 26672891.
31. ↑ Quayle FJ, Lowney JK (May 2006). "Colorectal lymphoma". Clin Colon Rectal Surg. 19 (2): 49–53. doi:10.1055/s-2006-942344. PMC 2780105. PMID 20011310.
32. ↑ Quayle, Frank; Lowney, Jennifer (2006). "Colorectal Lymphoma". Clinics in Colon and Rectal Surgery. 19 (2): 049–053. doi:10.1055/s-2006-942344. ISSN 1531-0043.
33. ↑ Arora M, Goldberg EM (July 2010). "Kaposi sarcoma involving the gastrointestinal tract". Gastroenterol Hepatol (N Y). 6 (7): 459–62. PMC 2933764. PMID 20827371.
34. ↑ Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS (2017). "Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review". Saudi J Gastroenterol. 23 (1): 67–70. doi:10.4103/1319-3767.199111. PMC 5329980. PMID 28139503.
35. ↑ Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH (September 2005). "Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting". J Chin Med Assoc. 68 (9): 411–8. doi:10.1016/S1726-4901(09)70156-X. PMID 16187597.
36. ↑ Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.
37. ↑ Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.
38. ↑ Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.
39. ↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
40. ↑ DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
41. ↑ 41.0 41.1 Fakhoury M, Negrulj R, Mooranian A, Al-Salami H (2014). "Inflammatory bowel disease: clinical aspects and treatments". J Inflamm Res. 7: 113–20. doi:10.2147/JIR.S65979. PMC 4106026. PMID 25075198.
42. ↑ Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.CS1 maint: Unrecognized language (link)
43. ↑ Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003). "The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT". Acta Radiol. 44 (6): 574–82. PMID 14616200.
44. ↑ Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.

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