Massive bleeding and perforation due to post-colectomy pan-enteritis with a significant response to biologic in a patient with ulcerative colitis: a case report.

IF 0.7 Q4 SURGERY
Kenichiro Toritani, Hideaki Kimura, Manabu Maebashi, Kazuki Kurimura, Serina Haruyama, Yoshinori Nakamori, Mao Matsubayashi, Reiko Kunisaki, Reiko Tanaka, Satoshi Fujii, Itaru Endo
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Abstract

Background: Post-colectomy pan-enteritis in ulcerative colitis (UC) is very rare, but it is often severe and fatal. We present a case of massive bleeding and perforation due to post-colectomy pan-enteritis, which showed a significant response to biologics in a UC patient.

Case presentation: A 30-year-old woman with a 5-month history of pancolitis UC underwent subtotal colectomy with ileostomy and mucosal fistula for refractory UC. She was diagnosed with small bowel obstruction on postoperative day (POD) 8 and bowel bleeding was observed on POD18. Reoperation was performed for bowel obstruction and bleeding on POD20. Intraoperatively, adhesive small bowel obstruction in the ileum and multiple erosions and ulcers with perforation were observed throughout the small bowel. We diagnosed post-colectomy pan-enteritis, and jejunostomy, lavage, adhesiolysis, and a simple closure of the perforated ileum were performed. High-dose steroid therapy for pan-enteritis was administered immediately after reoperation, and infliximab was administered because of worsening bleeding on day 3 after reoperation. Bleeding decreased one day after biologic administration and bleeding completely disappeared on day 10 after biologic administration. Specimens obtained from the terminal ileum at colectomy showed a normal ileum without inflammation and villus atrophy, while specimens from the perforated ileum showed congestion, villous atrophy, epithelial erosion, and mononuclear cell infiltration. No cryptitis, crypt distortion, or basal plasmacytosis (common characteristics in UC) were observed in either specimen.

Conclusion: An early diagnosis and intervention are important for post-colectomy pan-enteritis, and infliximab may be effective. Post-colectomy pan-enteritis with a multiple ulcer phenotype has different histological characteristics from UC and may have a different pathogenesis.

一名溃疡性结肠炎患者因结肠切除术后泛肠炎导致大出血和穿孔,且对生物制剂有明显反应:病例报告。
背景:溃疡性结肠炎(UC)结肠切除术后泛肠炎非常罕见,但往往病情严重且致命。我们介绍了一例因结肠切除术后泛肠炎而导致大量出血和穿孔的病例,该病例显示出 UC 患者对生物制剂的显著反应:病例介绍:一名 30 岁的女性,因患胰腺炎 UC 5 个月,接受了结肠次全切除术、回肠造口术和粘膜瘘,以治疗难治性 UC。她在术后第 8 天(POD)被诊断为小肠梗阻,在第 18 天(POD)观察到肠道出血。术后第 20 天,因肠梗阻和出血再次手术。术中观察到回肠有粘连性小肠梗阻,整个小肠有多处糜烂和溃疡,并伴有穿孔。我们诊断为结肠切除术后泛肠炎,并对穿孔的回肠进行了空肠造瘘、灌洗、粘连溶解和简单缝合。再次手术后立即使用大剂量类固醇治疗泛肠炎,由于再次手术后第 3 天出血情况恶化,又使用了英夫利昔单抗。使用生物制剂一天后出血量减少,使用生物制剂10天后出血完全消失。结肠切除术时从末端回肠获得的标本显示回肠正常,没有炎症和绒毛萎缩,而从穿孔的回肠获得的标本显示充血、绒毛萎缩、上皮糜烂和单核细胞浸润。两种标本均未观察到隐窝炎、隐窝变形或基底浆细胞增多(UC 的常见特征):结论:早期诊断和干预对结肠切除术后泛肠炎非常重要,英夫利昔单抗可能有效。结肠切除术后泛肠炎的多溃疡表型与 UC 的组织学特征不同,发病机制也可能不同。
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