Late-Onset of Acute Severe Ulcerative Colitis: Clinical Case

2017 ◽  
Vol 35 (1-2) ◽  
pp. 45-49 ◽  
Author(s):  
A.E. Dorofeyev ◽  
O.A. Rassokhina ◽  
A.A. Dorofeyeva
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Case ◽  
Late Onset ◽  
Lower Abdominal Pain ◽  
Well Being ◽  
Stool Frequency ◽  
Careful Examination ◽  
Histological Evaluation ◽  
Architectural Distortion ◽  
Infectious Colitis

Ulcerative colitis (UC) in adult age requires more careful examination because more often it turns out to be a complication related to the precancer condition. The onset of colitis in older age is predicted to follow a more aggressive clinical course and requires more frequent hospitalizations and steroids prescription in contrast to its onset in young patients. Even as this remains unclear, we present here a clinical case of late onset of acute severe UC to represent interesting clinical peculiarities and response to the therapy. Patient P., a 57-year-old male complained of 8 days of bloody diarrhea and lower abdominal pain. He reported having up to 3-5 urgent stool per day and 3-4 stool per night weight loss with dehydration. Stool culture was negative for infection, but fecal leukocytes were present. Flexible colonoscopy and biopsies were performed, which showed friable and erythematous mucosa with erosions and ulcers in a diffuse circumferential distribution from the anal verge to the cecum. There were no pseudomembranes. Histological evaluation revealed acute inflammation without architectural distortion consistent with either acute infectious colitis or new inflammatory bowel disease, favoring UC. Treatment for presumed UC is initiated with mesalazine 8 g daily: 4 g orally, 4 g per rectum and prednisone at 40 mg orally daily. After 48 h, stool frequency was 12 times per day (2 per night) with urgency, and blood was seen in stool occasionally. Intravenous steroids were prescribed - 16 mg of dexamethasone. After 48 h, stool frequency reduced to 8 per day, 1-2 per night, with traces of blood in stool and general well-being was increased. But after 14 days, the condition did not change significantly. Infliximab 5 mg/kg was administered and after the first infusion, stool frequency reduced to 4 times per day without urgency and night diarrhea. Azathioprine 100 mg per day was prescribed after steroid (prednisone) withdrawal. But after the third infusion of infliximab, the patient felt pain along the intercostal nerves along with skin redness and itching. Herpes zoster virus infection was diagnosed. Famciclovir 750 mg per day was prescribed, azathioprine was stopped, infusions of infliximab were continued and after 12 months, patient was started on a monotherapy of infliximab 1 time per 8 weeks and he had stable remission.

scholarly journals P627 Change in urgency among ulcerative colitis patients: Analyses from the SPARC IBD

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S564-S566
Author(s):  
J Lewis ◽  
M Shan ◽  
X Xhou ◽  
A Naegeli ◽  
T Hunter
Keyword(s):  
Ulcerative Colitis ◽  
Well Being ◽  
Stool Frequency ◽  
Common Symptom ◽  
Physician Global Assessment ◽  
Chi Square ◽  
Bowel Movements ◽  
Urgency Symptoms ◽  
Baseline Characteristics ◽  
Fecal Urgency

Abstract Background The objective of this study was to assess the changes in prevalence and severity of fecal urgency in Ulcerative Colitis (UC) patients at 6-months from their enrollment visit. Methods Data from patients in the Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease (SPARC IBD) were analyzed. UC patients that had an enrollment visit and 6-month visit were included in these analyses. Fecal urgency at each visit was assessed on a scale ranging from 0 (none) to 4 (severe). The change in urgency status from enrollment visit to 6-months is categorized as Improvement (decrease of 1–3 points), No Change, or Worsening (increase of 1–3 points). Descriptive statistics and contingency tables were created to summarize baseline characteristics by fecal urgency group. Chi-square tests, Fisher’s exact tests, ANOVA and Wilcoxon rank sum tests were conducted to compare the distribution of baseline characteristics between change in urgency groups, with Bonferroni corrections used for multiple comparisons. Results Data from 272 UC patients were included in this analysis. 25% of UC patients had an improvement in urgency, 54.4% had no change, 20.6% had a worsening of urgency at 6-months from their enrollment visit. When compared to patients that had no change in urgency at 6-months, UC patients that had improvement in urgency were more likely to have a higher baseline UCDAI (p<0.0001), mean daily bowel movements (p<0.0001), mean daily liquid bowel movements (P<0.0001), elevated stool frequency relative to their normal when well (p<0.0001), liquid stool consistency (p=0.0418), blood in stools (p=0.0001), abdominal pain (p=0.0065), moderate/severe fecal urgency (p<0.0001), worse general well-being (p<0.0001), moderate/severe Physician Global Assessment (PGA) (p=0.0013), and steroid use (p=0.0287) (Table 1). When compared to patients with worsening urgency at 6-months, UC patients that had an improvement in urgency at 6-months were more likely to have a higher baseline UCDAI (p<0.0001), mean daily bowel movements (p<0.0001), mean daily liquid bowel movement (P<0.0001), more stool frequency relative to their normal when well (p<0.0001), moderate/severe fecal urgency (p<0.0001), worse general well-being (p=0.0053), and moderate/severe PGA (p=0.0022). There were no statistically significant differences in baseline characteristics between UC patients that had a worsening or no change in urgency at 6-months. Conclusion Fecal urgency is a common symptom among UC patients. Urgency is not a stable symptom, with nearly 50% experiencing either worsening or improvement over 6-months. Worse disease activity at enrollment in the cohort was associated with improved fecal urgency symptoms over 6-months.

scholarly journals Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Michio Itabashi ◽  
Yoshiko Bamba ◽  
Hisako Aihara ◽  
Kimitaka Tani ◽  
Ryousuke Nakagawa ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Anterior Wall ◽  
Middle Part ◽  
Presacral Space ◽  
Previous Surgery ◽  
Afferent Limb ◽  
Radiographic Findings ◽  
Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

scholarly journals Chronic vulval problems: A gynaecologist’s perspective

2016 ◽  
Author(s):  
Akanksha Sharma ◽  
Saritha Shamsunder ◽  
Geetika Khanna ◽  
Neeti Khunger ◽  
Vijay Zutshi
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Examination ◽  
Squamous Cell ◽  
Well Being ◽  
Careful Examination ◽  
Blue Dye ◽  
Lichen Sclerosus Et Atrophicus ◽  
Cell Hyperplasia ◽  
Duration Of Symptoms ◽  
The Mean

Introduction: Chronic vulval symptoms are common complaints in women seeking health care and can significantly interfere with a woman’s sexual function and sense of well being. Many practitioners feel diagnostically challenged, particularly by chronic or recurrent forms of vulval disease. The aim of this study was to assess the role of various diagnostic modalities in evaluation of chronic vulval symptoms. Methods: Between August 2012 and February 2014, 100 women presenting with chronic vulval symptoms (i.e. ≥ 3 months duration) were evaluated. All of them had a thorough clinical history taken including use of vulval washes and creams, a general and gynaecological examination. Patients having chronic vaginal discharge in addition had urethral, vaginal and cervical smear and culture. All women had a careful examination of the vulva with and without magnification. Vulval scrape cytology was taken after moistening the vulva with normal saline and stained by Pap stain. Colposcopy of the vulva was then carried out after applying 5% acetic acid and 1% toluidine blue dye. Vulval biopsy was taken from suspicious areas on colposcopy and further management was based on histopathology report. Results: The mean age of women in our study was 43.57 years (range 22-80 years.), 70% women were pre-menopausal and 30% were post-menopausal. The mean duration of symptoms was 1.625 years (range 6 months - 15 years) and atypical vulval hygiene practices (excessive washing with soaps) was used in 77% of women. The commonest presenting complaint was pruritus in 92% of women; visible lesions on vulva were seen in 20%, pain in 6% and burning sensation in vulva in 5% of women. The histopathology was abnormal in 77 patients; the most common histopathological finding was non-neoplastic epithelial disorders in 64 women {Squamous cell hyperplasia (n=52), Lichen Sclerosus et atrophicus (n=6), other dermatoses including lichen Planus (n=6)}. Vulvar Intra-epithelial Neoplasia (VIN) was seen in 6 patients, 5 were squamous type VIN and 1 was non-squamous type (Paget’s disease). Squamous cell carcinoma was seen in 3 patients; malignant melanoma, benign appendiceal tumor, angiofibroma and neurofibroma in 1 patient. Examination without magnification had sensitivity of 25.97% and with magnification was 29.87% and specificity was 100% for both of them. Cytology had sensitivity and specificity of 75.32% and 86.95% respectively and sensitivity and specificity of colposcopy was 77.92% and 17.39% respectively. Conclusion: Clinical examination with and without magnification had low sensitivity but were highly specific in diagnosing vulvar lesions. A normal vulval smear and colposcopy have a high negative predictive value and are very reassuring. Colposcopy and biopsy is the gold standard for diagnosis, however clinical examination with naked eyes and magnifying glass are invaluable and can diagnose most of the neoplastic lesions.

scholarly journals Management of Severe Attacks of Ulcerative Colitis with New Technologies

1990 ◽  
Vol 4 (7) ◽  
pp. 347-349
Author(s):  
M Campieri ◽  
P Gionchetti ◽  
A Belluzzi ◽  
M Tampieri ◽  
C Brignola ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Transverse Colon ◽  
Bowel Wall ◽  
New Technologies ◽  
Toxic Megacolon ◽  
Abdominal Ultrasound ◽  
Histological Evaluation ◽  
Excellent Correlation ◽  
Severe Ulcerative Colitis ◽  
Descending Colon

Barium enema and colonoscopy are contraindicated in severe attacks of ulcerative colitis because of the possibility of toxic megacolon and perforation. The authors have assessed abdominal ultrasound in 38 patients with severe ulcerative colitis. Ultrasound revealed bowel wall thicknesses ranging from 3.9 to 9.2 mm (mean 7.7) extending the whole length of the colon, to the transverse colon, and to the descending colon, respectively, in 18, 10 and eight patients. The degree of bowel thickening was related to the severity of inflammation based on clinical, sigmoidoscopic and histological evaluation. In two patients, ultrasound showed a thin bowel wall distended without motility, suggesting the diagnosis of toxic megacolon (confirmed radiologically). An excellent correlation (95%) was found between ultrasound and technetium-99 scanning. Ultrasound might be a reasonable first investigation in the assessment of patients with severe ulcerative colitis.

Individualised Homoeopathy in the Treatment of Onycholysis: An Evidence-Based Clinical Case Report

2021 ◽  
Vol 34 (03) ◽  
pp. 227-234
Author(s):  
Dhiraj Debnath ◽  
Abhiram Banerjee ◽  
Md Mostafijur Rahaman ◽  
Gurudev Choubey
Keyword(s):  
Case Report ◽  
Clinical Case ◽  
Outcome Measurement ◽  
Nail Plate ◽  
Life Quality ◽  
Well Being ◽  
Middle Finger ◽  
Final Visit ◽  
Measurement Scales ◽  
Main Complaint

Abstract Introduction Onycholysis is a chronic nail disorder characterised by the progressive separation of the nail plate from the underlying nail bed. Apart from causing pain and discomfort, it affects the quality of life of an individual due to its visualised cosmetic appearance. Case Summary A 45-year-old female presented with complete loss of nail plate of the left middle finger for 1 month. At the first visit, homoeopathic medicine Tuberculinum bovinum was prescribed and the patient was followed up periodically for 4 months. A series of photographs captured at the first visit and in subsequent visits objectively document the gradual regrowth of her nail plate. Various aspects of her subjective improvement were documented by three validated outcome measurement scales. The patient herself assessed that, after 4 months of follow-up, she is ‘back to normal’ for her main complaint as well as for the overall well-being, which is documented as a +4 score in ‘Outcome in Relation to Impact on Daily Living’ (ORIDL) scale. The Dermatology Life Quality Index (DLQI) score was reduced from 20 at the first visit to 1 after 4 months of treatment. Modified Naranjo Criteria for Homeopathy (MONARCH) score recorded at the final visit (+8 in ‘-6 to +13’ scale) is suggestive of a high likelihood that the improvement in the patient can be attributed to the homoeopathic treatment provided. Conclusion This clinical case report is presented here to critically document the effect of individualised homoeopathic treatment in onycholysis within a plausible timeframe.

Disease patterns in late-onset ulcerative colitis: Results from the IG-IBD “AGED study”

2017 ◽  
Vol 49 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Walter Fries ◽  
Anna Viola ◽  
Natalia Manetti ◽  
Iris Frankovic ◽  
Daniela Pugliese ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Late Onset ◽  
Disease Patterns

scholarly journals Antenatally Diagnosed Posterior Urethral Valve: A Case Report

2016 ◽  
Vol 5 (1) ◽  
pp. 42-45
Author(s):  
Mahzabeen Islam ◽  
Masudur Rahman ◽  
Sankar Narayan Dey ◽  
Netay Kumer Sharma ◽  
Mir Naz Farzana
Keyword(s):  
Clinical Presentation ◽  
Antenatal Diagnosis ◽  
Late Onset ◽  
Obstructive Uropathy ◽  
Lower Abdominal Pain ◽  
Posterior Urethral Valve ◽  
Caesarian Section ◽  
Common Cause ◽  
Obstructive Lesion ◽  
Urethral Valve

Posterior urethral valve (PUV) are the most common congenital obstructive lesion of the urethra and a common cause of obstructive uropathy in infancy. Clinical presentation depends on the severity of the obstruction. In case of severe obstruction, the diagnosis is usually made antenatally. Here, we present a case of antenatally diagnosed PUV of a fetus of a lady in her 9th month of pregnancy with mild lower abdominal pain for several hours. On ultrasound (US) examination, we found 36.5±2 weeks of pregnancy with mild to moderate oligohydramnios. Fetal urinary bladder was over distended; both the kidneys were grossly hydronephrotic and PUV like echo lucent area was seen at the prostatic region (Key hole sign). Emergency caesarian section (CS) was done and US of the baby showed typical US finding of PUV. The prognosis of antenatal diagnosis of PUV in early pregnancy is poor. But in this case due to the late onset of symptoms and as immediate necessary steps were taken, the baby was totally cured. This case was reported to aware about importance of antenatal anomaly scan and to share our experience. CBMJ 2016 January: Vol. 05 No. 01 P: 42-45

scholarly journals Combination of ulcerative colitis with cirrhosis of the liver in the outcome of primary sclerosing cholangitis

2020 ◽  
Vol 174 (5) ◽  
pp. 104-107
Author(s):  
A. V. Nikitin ◽  
A. I. Khavkin ◽  
T. A. Skvortsova ◽  
G. V. Volynets ◽  
A. O. Atameeva
Keyword(s):  
Ulcerative Colitis ◽  
Weight Loss ◽  
Primary Sclerosing Cholangitis ◽  
Liver Damage ◽  
Sclerosing Cholangitis ◽  
Clinical Case ◽  
Clinical Observation ◽  
Lower Extremities ◽  
Cirrhosis Of The Liver ◽  
Extraintestinal Manifestation

A clinical case of a combination of ulcerative colitis with cirrhosis in the outcome of primary sclerosing cholangitis in a twelve-year-old child is presented. The uniqueness of the clinical observation lies in the atypical onset of ulcerative colitis in the form of complaints of weakness and headache, as well as detected anemia of 3 severity. It is important that the child lacked diarrhea, blood in the stool, tenesmus, weight loss, and fever. Of the most characteristic signs of liver damage, only itching of the skin of the lower extremities was noted. As a result, the child was diagnosed with cirrhosis of the liver at the end of the extraintestinal manifestation of ulcerative colitis — primary sclerosing cholangitis.

scholarly journals NON-SPECIFIC ULCERATIVE COLITIS AND COVID-19, A CASE STUDY

2021 ◽  
Vol 5 (1) ◽  
pp. 89-92
Author(s):  
Z. P. Lemeshevskaya ◽  
◽  
M. V. Pavlukevich ◽  
N. I. Procopchik ◽  
◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Case ◽  
Clinical Laboratory ◽  
Clinical Course ◽  
Medical Documentation ◽  
Atypical Form ◽  
History Of ◽  
Hematoxylin And Eosin ◽  
Somatic Diseases

Background. COVID-19 infection keeps changing our understanding of its clinical course when associated with various somatic diseases. Objective. To present a clinical case of a patient with non-specific ulcerative colitis (NUC) and COVID-19 infection. Material and methods: medical documentation, general clinical, laboratory and instrumental data as well as histological examination of bioptates stained with hematoxylin and eosin that were obtained during colonoscopy. Results. The article presents a case history of a patient with manifestations of severe total NUC developed in association with the subclinical form of COVID-19 infection, the former being the cause of death in concomitant pathology. Conclusions. This clinical case describes a variant of an unfavorable outcome of NUC, one of the reasons for the manifestation of which was the atypical form of COVID-19 infection, which became a trigger for an autoimmune inflammatory process in the intestine. The accumulation of new knowledge about the features of the pathogenesis and manifestations of both pathologies will make it possible to improve the effectiveness of treatment and predict the course and outcomes of combined pathology.

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