Fulminant ulcerative colitis with a normal rectum
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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