This 53 year-old female suffering of longstanding ulcerative colitis. Pathophysiology Ulcerative colitis involves only the mucosa; it is characterized by the formation of crypt abscesses and a coexisting depletion of goblet cell mucin. In severe cases, the submucosa may be involved; in some cases, the deeper muscular layers of the colonic wall is also affected. Acute severe colitis may result in a fulminant colitis or toxic megacolon, which is characterized by a thin-walled, large, dilated colon that may eventually become perforated. Chronic disease is associated with pseudopolyp formation in about 15-20% of cases. Chronic and severe cases can be associated with areas of precancerous changes, such as carcinoma in situ or dysplasia. Anatomically, the large majority of cases involve the rectum; some patients develop terminal ileitis caused by an incompetent ileocecal valve. In these cases, about 30 cm of the terminal ileum is usually affected.
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