Multiple Rectal Ulcers (1 of 110)

This is the case of 50 year-old female, three years previous was diagnosed as having ulcerative colitis in another country. The clinical course began with severe constipation during 6 month following with bloody loose bowel movements. Now presented with frequent episodes of rectal bleeding with mucus, diarrhea, rectal pain, urgency, tenesmus, intermitent severe abdominal pain referred to left flank, and pitting edema of the both leg, Hb 10.8 gr/dl. hypoalbuminemia, elevated platelet count, extreme fatigue, patient looks pale and weight loss of 30 libs. CT scan shows ingorged splenic angle and descending colon with ascites. Pacient is admitted for stabilization. Because of the severity of the clinical picture and the severity and extention of the pancolitis, surgery was initially suggested as a treatment option, but patient instead chose medical management, which included prednisone 50 mg PO daily for 10 days, gradually diminishing doses by 10 mg/day every 10 days, plus sulfidine 2 tablets PO after every meal. Corticosteroids should be used to treat active ulcerative colitis. They have no role in maintenance treatment to prevent relapse. The dosage and routes of administration vary with the severity and location of ulcerative colitis. After 10 days of treatment and 18 after the colonoscopy, the patient is readmitted to the hospital because of increased abdominal pain and sepsis. WB counts: 21,900 with 98% neutrophils, with a hemoglobin of 10 g/dl. Next day, patient presents with hypotension, tachycardia and signs of tissue hypoperfusion those sign are consistent of toxic megacolon. The patient underwent emergency surgery (Colectomy with ileostomy)