Skip to Main Content

+

  • • Diffuse inflammatory disease confined to mucosa and submucosa

    • Crypts of Lieberkühn abscesses

    • Most commonly affects rectum

    • May spread to involve entire colon and distal ileum (backwash ileitis)

    • Diseased areas are contiguous

    • Increase in colorectal cancer risk

++

Epidemiology

+

  • • Bimodal age distribution

    • -15-30 years

      -60-80 years

    • Females affected slightly more than males

    • Incidence 5-12/100,000

    • Etiology unknown

++

Symptoms and Signs

+

  • • Rectal bleeding

    • Diarrhea

    • Tenesmus

    • Rectal urgency

    • Anal incontinence

    • Crampy abdominal pain

    • Fever

    • Vomiting

    • Weight loss

    • Dehydration

    • Extracolonic manifestations, including arthropathy, uveitis, iritis, pyoderma gangrenosum, and aphthous ulcers

++

Laboratory Findings

+

  • • Anemia

    • Leukocytosis

    • Elevated ESR

    • Hypoalbuminemia

    • Electrolyte depletion

++

Imaging Findings

+

  • Sigmoidoscopy

    • -Loss of normal vascular pattern

      -Friable

      -Hyperemic rectal mucosa

      -Mucosal granularity

      -Ulcers with bleeding and purulent exudates in advanced disease

    Barium enema

    • -Diffuse reticulated pattern

      -"Collar button" ulcers

      -Disappearance of haustral markings ("lead pipe")

      -Shortening of colon

    Abdominal x-ray

    • -Colonic dilation

      -Loss of haustral markings

    CT scan of abdomen

    • -May be helpful in puzzling cases

      -Colonic dilation

      -Loss of haustral markings

+

  • • No radiographic, histologic, endoscopic findings pathognomonic

    • Infectious colitis

    • Mesenteric insufficiency

    • Neoplasm

    • Antibiotic-associated colitis

    • Chagas disease

++

Rule Out

+

  • • Infectious diarrhea (shigellosis, salmonellosis, E coli, amebiasis)

    • Crohn disease

    • Malignancy

    • Diverticular disease

    Clostridium difficile colitis

    • Toxic megacolon

    • Infectious colitis and pseudomembranous colitis

+

  • • Flexible sigmoidoscopy and colonoscopy

    • Contrast enema

    • CBC

    • Metabolic panel

    • Liver function panel

++

When to Admit

+

  • • Dehydration or malnutrition

    • Severe rectal bleeding

    • Abdominal pain

    • Bowel obstruction

    • Intractable diarrhea

    • Severe, acute, or fulminant attack

++

When to Refer

+

  • • Unclear diagnosis

    • Impending perforation

    • Suspicion of toxic megacolon

+

  • • Initially, medical unless complications arise

    • Surgery potentially curative

    • Treatment focus on containing and reducing inflammation

++

Surgery

+

  • • Total colectomy, rectal mucosectomy, and ileoanal anastomosis

    • Proctocolectomy with ileostomy or continent ileal pouch

    • Subtotal colectomy with ileorectal anastomosis

    • Emergent procedures should be tailored to fit the extent of the illness; typically total abdominal colectomy and ileostomy

++

Indications

+

  • • Emergency surgery for perforation

    • Urgent surgery for

    • -Medically refractory toxic megacolon

      -Massive hemorrhage

      -Fulminant acute flare unresponsive to medication

      -Acute obstruction

      -Suspicion or demonstration of colorectal cancer

    • Medically refractory chronic disease resulting in malnutrition, complications from medical management, or inability to work or perform activities of daily living

++

Medications

+

  • • Sulfasalazine

    • Corticosteroids

    • Mesalamine

    • Cyclosporine for steroid-resistant colitis

++

Treatment Monitoring

+

  • • Endoscopy

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.