Rectal biopsy in the diagnosis of Crohn's disease: value of multiple biopsies and serial sectioning.

We performed a retrospective evaluation of 243 rectal biopsies from 90 patients who eventually had Crohn's disease proven clinically or by surgery. A portion of each rectal biopsy was serially sectioned. Twenty-five of the 90 patients (28%) had epithelioid granulomas. Half of these patients had an epithelioid granuloma in only one of two or more biopsies. Sixteen percent of these granulomas were so small as to be seen in only six or less successive serial 4-microM sections. This high yield of granulomas is probably attributable to the examination of at least 90 serial sections, usually from each of two rectal biopsies per patient. Using partial serial sectioning, epithelioid granulomas were found almost as frequently in grossly normal as in grossly abnormal appearing mucosa. No granulomas were seen in suitable controls including normals and patients with ulcerative colitis or other diseases. When the differential diagnosis between idiopathic ulcerative colitis and Crohn's disease is uncertain, we recommend taking two rectal biopsies and serially sectioning part of each.