Presentation
Known ulcerative colitis. Short history of progressively worsening left-sided abdominal pain and diarrhea. Raised inflammatory markers.
Patient Data
Florid thickening of the colon with edema and surrounding fat stranding and edema from the splenic flexure through to the distal sigmoid colon, with sparing of the rectum. No colon dilatation or perforation. Uncomplicated umbilical hernia.
Appearances consistent with active ulcerative colitis with sparing of the rectum, and no signs of toxic megacolon.
HISTOLOGY REPORT
Clinical Details: Subtotal colectomy for ulcerative colitis. Not responding to treatment.
Macroscopic: Length of large bowel 1220 mm with appendix 60 mm and terminal ileum 21 mm. On opening the distal 820 mm is ulcerated with extensive pseudopolyp formation.
Microscopic: The large bowel shows extensive mucosal ulceration with pseudopolyp formation. In places the ulcers are deep extending into the muscularis propria and in one area there is no muscle separating the ulcer from the subserosal tissues. The remaining mucosa shows areas of architectural distortion and mild mucin depletion which increases in severity distally. The lamina propria comprises a mixed lymphoplasmacytic infiltrate with active inflammation, cryptitis and crypt abscesses. There is abundant granulation tissue. The terminal ileum and the appendix do not show any significant abnormalities. Three lymph nodes are identified and these show reactive changes. There is no evidence of amoebae, CMV inclusions, granulomas, dysplasia or malignancy. There is no transmural lymphoid inflammation.
Conclusion: Subtotal colectomy - fulminant ulcerative colitis.
Case Discussion
Due to lack of improvement with medical therapy, the patient underwent surgery which confirmed acute fulminant ulcerative colitis with no perforation.