Severe Gastroduodenitis Associated With Ulcerative Colitis After Total Colectomy Successfully Treated With Endoscopic Hemostasis and Oral Tacrolimus

Abstract

Herein, we report a rare case of gastroduodenitis associated with ulcerative colitis (UC). A 42-year-old man was diagnosed with UC 1 year prior to admission to our hospital. The patient underwent a 3-stage total colectomy and ileal pouch-anal anastomosis for severe UC. Two months after the second surgery, the patient was admitted to our hospital with nausea, appetite loss, abdominal pain, and frequent bloody diarrhea. Blood analysis showed an increase in white blood cell count and C-reactive protein levels. Esophagogastroduodenoscopy (EGD) revealed diffuse UC-like inflammation from the stomach to the duodenum and ulcers in the descending and horizontal regions of the duodenum. Pouchoscopy revealed ulcers and friable mucosa within the pouch. The patient was diagnosed with gastroduodenitis associated with UC (GDUC) and diversion pouchitis based on endoscopic and pathological findings. Inflammation in the GDUC was resistant to oral crushed mesalazine and prednisolone (60 mg/day) infusion, resulting in arterial bleeding from the duodenal ulcer and bloody stool in the stoma. Endoscopic hemostasis was performed for the duodenal ulcer. Oral tacrolimus was initiated because the inflammation was steroid-resistant. Approximately 2 weeks after the initiation of tacrolimus, abdominal symptoms, including bloody diarrhea, disappeared, and EGD showed improvement in the GDUC.