Colitis with a Tentative Diagnosis of Acute Crohn's Colitis Which Turned Out Most Likely to Be Ulcerative Colitis by the Follow-up Examinations of the Retained Rectum, Report of a Case F. Konishi 1 , T. Muto 1 , J. Kamiya 1 , H. Shigematsu 1 1The First Department of Surgery, Faculty of Medicine, University of Tokyo pp.313-316
Published Date 1984/3/25
DOI https://doi.org/10.11477/mf.1403106979
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 The patient was a 31 year-old man with the chief complaint of bloody diarrhea and abdominal pain. Ulcerative colitis was suspected by barium enema and colonoscopy. Because the patient showed no response to the steroid treatment, total colectomy and ileostomy was performed. Proximal end of the rectum was closed (Hartmann's procedure). Examination of the resected specimen showed extensive ulceration in the rectum, sigmoid and the descending colon with small islands of retained mucosa. Proximal to this ulcerated area, for about 30 cm, there were discontinuous scattered small ulcerations with intervening normal looking mucosa. Histologically, in the ulcerated area there were fissuring ulcerations and transmural inflammation, and in the area with discontinuous ulcers there were scattered foci of acute inflammatory change some of which were located at the site of lymphoid follicle. Because of those findings tentative diagnosis of unclassified colitis possibly Crohn's colitis was made.

 Subsequent follow-up study was performed by repeating proctoscopy and biopsy of the residual rectum for two years and nine months. Ileorectal anastomosis was performed about two years after the colectomy. The findings of the follow-up examinations did not show changes of Crohn's disease and were consistent with chronic ulcerative colitis. In addition to this, double contrast barium study of the small intestine and endoscopy of the ileum showed no abnormalities. Because of the results of the follow-up examinations most likely diagnosis turned out to be ulcerative colitis.

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