Ulcerative colitis

Case contributed by Dr Hala Maher

Presentation

Acute abdominal pain, malaise with a history of bleeding per rectum for 8 months.

Patient Data

Age: 45 years
Gender: Male
Ultrasound

Thickened duodenal and colonic wall is noted along with suspected peri vesical rim of fluid.

CT

Contrast enhanced CT of abdomen and pelvis

The entire colon is showing thickened-wall with an increased enhancement of the wall more evident at the terminal ileum and cecal segments. Also, a small volume of peri colonic free fluid with fat stranding and congested vasculature are noted. 

The lead pipe sign of the colon is highly suggestive of ulcerative colitis.

Incidentally seen target sign appearance at the left side of the abdomen suggestive of small bowel intussusception with no definite signs of bowel ischemia nor obstruction.

Case Discussion

The symptoms of bleeding per rectum along with the ultrasound and CT scan signs especially the lead pipe appearance of the colon are highly suggestive of ulcerative colitis that has been confirmed through colonoscopy and gastroscopy with biopsy intake and confirmed the diagnosis.

Transient intermittent small bowel intussusception incidentally discovered as it often presents with nonspecific symptoms like intermittent pain, vomiting, melena, and weight loss which is similar to symptoms of this patient chronic disease (ulcerative colitis) or even completely asymptomatic.

This condition is rare and idiopathic or due to abnormal peristalsis due to chronic bowel disease and also reduces spontaneously without any surgical intervention as in this case as the patient discharge two days after CT scan has been done in a good general condition.

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Case information

rID: 83013
Published: 21st Oct 2020
Last edited: 22nd Oct 2020
Inclusion in quiz mode: Included
Institution: Dr Abdul Rahman Al Mishari Hospital