The American Journal of Digestive Diseases

, Volume 12, Issue 9, pp 923–933 | Cite as

Fulminant ulcerative colitis with a normal rectum

  • Marshall Sparberg
  • Kermit B. Knudsen


Ulcerative colitis usually begins in the rectum and can be diagnosed proctoscopically in over 90% of patients. A normal rectum with severe disease is extremely uncommon and represents a significant barrier to the prompt establishment of a proper diagnosis.

Four cases of fulminant ulcerative colitis with normal rectal mucosa as observed proctoscopically are presented. One case was complicated by toxic megacolon and three by hemorrhage. Emergency surgery was required in two patients, with one death resulting. Elective surgery was performed on one patient. The resected tissue was typical of ulcerative colitis with no evidence of granulomatous colitis. The barium enema examination proved to be the most useful diagnostic tool, even when performed during the acute episode. Some explanations for this phenomenon are given.


Barium Severe Disease Ulcerative Colitis Diagnostic Tool Barium Enema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bacon, H. F.,Ulcerative Colitis. Lippincott, Philadelphia, 1958. p. 9.Google Scholar
  2. 2.
    Jones, T. E. The surgical treatment of ulcerative colitis.JAMA 111:2076, 1938.Google Scholar
  3. 3.
    Kiefer, E. D., andJordan, S. M. A review of the problem of chronic ulcerative proctitis.Trans Amer Proct Soc 45:487, 1946.Google Scholar
  4. 4.
    Kelley, M. L., Jr. Chronic ulcerative colitis at a medical center in western New York state: Comnlications and course.New York J Med 63:2061, 1963.PubMedGoogle Scholar
  5. 5.
    Linder, A. E., King, R. C, andBolt, R. J. Chronic ulcerative colitis: A clinical appraisal and follow-up study.Gastroenterology 39:153, 1960.PubMedGoogle Scholar
  6. 6.
    Matts, S. G. F. The value of rectal biopsy in the diagnosis of ulcerative colitis.Quart J Med 30:393, 1961.PubMedGoogle Scholar
  7. 7.
    Truelove, S. C., andEdwards, F. C. The course and prognosis of ulcerative colitis.Gut 4: 299, 1963.Google Scholar
  8. 8.
    Truelove, S. C, andEdwards, F. C. The course and prognosis of ulcerative colitis.Gut 5:1, 1964.Google Scholar
  9. 9.
    Sparberg, M., Fennessy, J. J., andKirsner, J. B. Ulcerative proctitis and mild ulcerative colitis: A study of 220 patients.Medicine 45:391, 1966.PubMedGoogle Scholar
  10. 10.
    Bercovitz, Z. T. Ulcerative colitis in older age patients.Gastroenterology 39:28, 1960.PubMedGoogle Scholar
  11. 11.
    Truelove, S. C, andRichards, W. C. D. Biopsy studies in ulcerative colitis.Brit Med J 1: 1315, 1956.Google Scholar
  12. 12.
    Dick, A. P., andGrayson, M. J. Ulcerative colitis: A follow-up investigation with mucosal biopsy studies.Brit Med J 1:160, 1961.Google Scholar
  13. 13.
    Watts, J. McK., Thompson, H., andGoligher, J. C. Sigmoidoscopy and cytology in the detection of microscopic diseases of the rectal mucosa in ulcerative colitis.Gut 7:288, 1966.Google Scholar
  14. 14.
    Marshak, R. H., Korelitz, B. I., Klein, S. H., Wolf, B. S., andJanowitz, H. D. Toxic dilatation of the colon in the course of ulcerative colitis.Gastroenterology 38:165, 1960.PubMedGoogle Scholar
  15. 15.
    Lockhart-Mummery, H. E., andMorson, B. C. Crohn's disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis.Gut 1:87, 1960.PubMedGoogle Scholar
  16. 16.
    Marshak, R. H., Linder, A. E., andJanowitz, H. D. Granulomatous colitis.Gut 7: 258, 1966.Google Scholar
  17. 17.
    Lockhart-Mummery, H. E., andMorson, B. C. Crohn's disease of the large intestine.Gut 5: 493, 1964.Google Scholar
  18. 18.
    Farmer, R. G., Hawk, W. A., andTurnbull, R. B. Crohn's disease of the colon: A clinical and pathological comparison with ulcerative colitis.Gastroenterology 50:841, 1966.Google Scholar

Copyright information

© Hoeber Medical Division • Harper & Row, Publishers, Incorporated 1967

Authors and Affiliations

  • Marshall Sparberg
    • 1
    • 2
  • Kermit B. Knudsen
    • 1
    • 2
  1. 1.From the Gastroenterology Service, Department of MedicineWilford Hall USAF HospitalLackland AFB
  2. 2.Chicago

Personalised recommendations