It was his usual practice, when possible, to extend his evaluation beyond the colon into the last section of the ileum, the tail end of the small intestine. Most gastroenterologists limit their screening examinations of healthy, asymptomatic patients to the colon. The ileum is not scoped during a routine screening because doing so takes more time and because the chance of finding something significant is small. But Chan had been trained by a doctor who specialized in inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. A simple colonoscopy will reveal ulcerative colitis, when present. But only half of those with Crohn’s disease will have evidence of it in their colons. The chance of making that diagnosis goes up markedly when the terminal ileum is included.
As Chan advanced his scope, he could see that the valve was distorted by scar tissue — so much so that the connection was too narrow for his instrument to enter. Bringing his scope as close to the opening as he could, he saw that the tissue on the other side was an angry red and dotted with ulcers. They would have to wait for the biopsies to come back, but Chan suspected Crohn’s