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An unusual complication of colitis

Zimbwa, Truman Austin, Owen, R., Thomas, G., Hargest, Rachel and Williams, Geraint Trefor 2010. An unusual complication of colitis. Gut 59 (3) , p. 364. 10.1136/gut.2009.179689

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An 18-year-old man with a 13 month history of ulcerative coltis (UC) was admitted with a progressive history of worsening left-sided abdominal pain, diarrhoea, rectal bleeding and weight loss. UC had been diagnosed on flexible sigmiodoscopy and biopsies, which confirmed moderately active colitis to the point of insertion (distal descending colon). Initially he was commenced on mesalazine and steroids, but his disease remained active and azathioprine was introduced after 4 months. Despite this he continued to suffer active symptoms, and a colonoscopy was performed after 8 months. This demonstrated some improvement, with mildly active colitis evident to the sigmoid. The full extent of his colitis was not established as the procedure was limited to the sigmoid because of patient discomfort. Over the next 4 months his condition and blood tests gradually worsened to the point that he required admission. On examination, he was feverish and tachycardiac. Abdominal palpation demonstrated a left lower quadrant “mass” and tenderness, but no guarding. Laboratory analysis identified a microcytic anaemia (haemoglobin 5.6 g/dl), normal white cell count, elevated platelet count (666×109/l), raised C-reactive protein (199 mg/l) and a low albumin (23 g/dl). An abdominal radiograph showed right-sided faecal loading. He failed to improve, despite treatment with hydrocortisone and intravenously, and a CT scan of his abdomen and pelvis was requested (figure 1).

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Additional Information: Editor's quiz: GI snapshot
Publisher: BMJ Publishing Group
ISSN: 0017-5749
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Last Modified: 31 Jul 2018 10:02

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