The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case report
Abstract Background Diversion colitis (DC) is characterized by nonspecific inflammation in the remaining colon or rectum, and loss of the fecal stream plays a major role in the disease’s development. Although the majority of patients are asymptomatic, medical and/or surgical treatment is required fo...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-08-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-018-0490-8 |
| _version_ | 1818991338455040000 |
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| author | Nao Kakizawa Shingo Tsujinaka Yasuyuki Miyakura Rina Kikugawa Fumi Hasegawa Hideki Ishikawa Sawako Tamaki Jun Takahashi Toshiki Rikiyama |
| author_facet | Nao Kakizawa Shingo Tsujinaka Yasuyuki Miyakura Rina Kikugawa Fumi Hasegawa Hideki Ishikawa Sawako Tamaki Jun Takahashi Toshiki Rikiyama |
| author_sort | Nao Kakizawa |
| collection | DOAJ |
| description | Abstract Background Diversion colitis (DC) is characterized by nonspecific inflammation in the remaining colon or rectum, and loss of the fecal stream plays a major role in the disease’s development. Although the majority of patients are asymptomatic, medical and/or surgical treatment is required for those who are symptomatic. There is a particular interest on how to manage patients with acute and severe clinical presentations, but the pathogenesis is not fully understood. We report the rare case of a man with acute and severe DC mimicking ulcerative colitis (UC) with extra-intestinal manifestations that was successfully managed with surgical treatment. Case presentation A 68-year-old man with a history of laparoscopic intersphincteric resection of the rectum with diverting loop ileostomy for lower rectal cancer suffered from anastomotic stenosis requiring repeated endoscopic dilatation. His loop stoma was not reversed because these treatments were unsuccessful. He denied having a history of inflammatory bowel disease. Twelve years postoperatively, he developed a perineal abscess requiring drainage. Subsequently, he developed a high-grade fever, bloody discharge per anus, and skin ulcers in the right ankle and around the stoma. Because culture tests were negative for bacteria, it was deemed that his acute illness reflected an inflammatory response rather than an infectious disease. Colonoscopy revealed anastomotic stenosis, a colonic fistula, and mucosa that hemorrhaged easily, with lacerations. A pathological examination with biopsy revealed inflammatory infiltration without malignancy. After reviewing the patient’s clinical episodes and discussing the case with physicians in multiple specialties, we performed total colectomy with end ileostomy in accordance with the abdominoperineal resection. The postoperative course was uneventful. A resected specimen showed atrophic mucosa with the disappearance of haustra in the distal colon, as well as edematous and dilated mucosa in the proximal colon. The pathological diagnosis was suggestive of UC, including erosion and ulceration in edematous wall, crypt abscess, and inflammatory infiltration into the mucosa. The skin ulcers in the right ankle and around the stoma healed over time. Conclusions DC can eventuate in a long-term period after fecal diversion surgery, possibly with extra-intestinal manifestations mimicking UC. Surgical treatment seems feasible for patients with acute and severe DC. |
| first_indexed | 2024-12-20T20:08:41Z |
| format | Article |
| id | doaj.art-3fa50166afeb4d91852987f1722aafe7 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-20T20:08:41Z |
| publishDate | 2018-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-3fa50166afeb4d91852987f1722aafe72022-12-21T19:27:52ZengSpringerOpenSurgical Case Reports2198-77932018-08-01411710.1186/s40792-018-0490-8The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case reportNao Kakizawa0Shingo Tsujinaka1Yasuyuki Miyakura2Rina Kikugawa3Fumi Hasegawa4Hideki Ishikawa5Sawako Tamaki6Jun Takahashi7Toshiki Rikiyama8Department of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityDepartment of Surgery, Saitama Medical Center, Jichi Medical UniversityAbstract Background Diversion colitis (DC) is characterized by nonspecific inflammation in the remaining colon or rectum, and loss of the fecal stream plays a major role in the disease’s development. Although the majority of patients are asymptomatic, medical and/or surgical treatment is required for those who are symptomatic. There is a particular interest on how to manage patients with acute and severe clinical presentations, but the pathogenesis is not fully understood. We report the rare case of a man with acute and severe DC mimicking ulcerative colitis (UC) with extra-intestinal manifestations that was successfully managed with surgical treatment. Case presentation A 68-year-old man with a history of laparoscopic intersphincteric resection of the rectum with diverting loop ileostomy for lower rectal cancer suffered from anastomotic stenosis requiring repeated endoscopic dilatation. His loop stoma was not reversed because these treatments were unsuccessful. He denied having a history of inflammatory bowel disease. Twelve years postoperatively, he developed a perineal abscess requiring drainage. Subsequently, he developed a high-grade fever, bloody discharge per anus, and skin ulcers in the right ankle and around the stoma. Because culture tests were negative for bacteria, it was deemed that his acute illness reflected an inflammatory response rather than an infectious disease. Colonoscopy revealed anastomotic stenosis, a colonic fistula, and mucosa that hemorrhaged easily, with lacerations. A pathological examination with biopsy revealed inflammatory infiltration without malignancy. After reviewing the patient’s clinical episodes and discussing the case with physicians in multiple specialties, we performed total colectomy with end ileostomy in accordance with the abdominoperineal resection. The postoperative course was uneventful. A resected specimen showed atrophic mucosa with the disappearance of haustra in the distal colon, as well as edematous and dilated mucosa in the proximal colon. The pathological diagnosis was suggestive of UC, including erosion and ulceration in edematous wall, crypt abscess, and inflammatory infiltration into the mucosa. The skin ulcers in the right ankle and around the stoma healed over time. Conclusions DC can eventuate in a long-term period after fecal diversion surgery, possibly with extra-intestinal manifestations mimicking UC. Surgical treatment seems feasible for patients with acute and severe DC.http://link.springer.com/article/10.1186/s40792-018-0490-8Diversion colitisUlcerative colitisInflammatory bowel diseaseExtra-intestinal manifestationsLoop stomaAnastomotic stenosis |
| spellingShingle | Nao Kakizawa Shingo Tsujinaka Yasuyuki Miyakura Rina Kikugawa Fumi Hasegawa Hideki Ishikawa Sawako Tamaki Jun Takahashi Toshiki Rikiyama The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case report Surgical Case Reports Diversion colitis Ulcerative colitis Inflammatory bowel disease Extra-intestinal manifestations Loop stoma Anastomotic stenosis |
| title | The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case report |
| title_full | The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case report |
| title_fullStr | The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case report |
| title_full_unstemmed | The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case report |
| title_short | The surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis: a case report |
| title_sort | surgical treatment of acute and severe diversion colitis mimicking ulcerative colitis a case report |
| topic | Diversion colitis Ulcerative colitis Inflammatory bowel disease Extra-intestinal manifestations Loop stoma Anastomotic stenosis |
| url | http://link.springer.com/article/10.1186/s40792-018-0490-8 |
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