Fulminant ulcerative colitis with a normal rectum
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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.
KeywordsBarium Severe Disease Ulcerative Colitis Diagnostic Tool Barium Enema
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- 1.Bacon, H. F.,Ulcerative Colitis. Lippincott, Philadelphia, 1958. p. 9.Google Scholar
- 2.Jones, T. E. The surgical treatment of ulcerative colitis.JAMA 111:2076, 1938.Google Scholar
- 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
- 7.Truelove, S. C., andEdwards, F. C. The course and prognosis of ulcerative colitis.Gut 4: 299, 1963.Google Scholar
- 8.Truelove, S. C, andEdwards, F. C. The course and prognosis of ulcerative colitis.Gut 5:1, 1964.Google Scholar
- 11.Truelove, S. C, andRichards, W. C. D. Biopsy studies in ulcerative colitis.Brit Med J 1: 1315, 1956.Google Scholar
- 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.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
- 16.Marshak, R. H., Linder, A. E., andJanowitz, H. D. Granulomatous colitis.Gut 7: 258, 1966.Google Scholar
- 17.Lockhart-Mummery, H. E., andMorson, B. C. Crohn's disease of the large intestine.Gut 5: 493, 1964.Google Scholar
- 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