Ulcerative colitis with mucosal lesions in duodenum: Two case reports.

Authors:
Yandi Liu
Yandi Liu
Curtin University of Technology
Australia
Jifang Cui
Jifang Cui
Institute of Psychology
China
Hai Qin
Hai Qin
Institute of Molecular Medicine and Genetics
United States
Yang Shi
Yang Shi
Boston Children's Hospital
Boston | United States
Shiwu Zhang
Shiwu Zhang
Tianjin Medical University
China
Yongjie Zhao
Yongjie Zhao
Tianjin Peoples' Hospital

Medicine (Baltimore) 2019 Apr;98(14):e15035

Department of General Surgery, Tianjin Union Medical Center, Tianjin, China.

Rationale: Ulcerative colitis (UC) is a chronic, nonspecific, inflammatory disease of the colon. Colorectal is the main target organ of UC, while other digestive tract involvement is rare. This report describes 2 rare cases of duodenal mucosa lesions in patients with UC after total colectomy.

Patient Concerns: In case 1, a patient of 45-year-old with intermittent diarrhea and bloody mucosanguineous feces who was diagnosed as UC, revealed diffuse erosive ulcers in the descending duodenum through gastroscopy after total colectomy. In case 2, a 55-year-old Chinese female with UC, aggravated to colon cancer and received total colectomy. Eighteen months after surgery, the patient was admitted to hospital following upper abdominal pain and acid regurgitation. A gastroscopy found inflammation in the descending part of the duodenum.

Diagnosis: UC, duodenal mucosa lesions INTERVENTIONS:: In case 1, the patient was treated with oral mesalazine (1 g/tid) and hydrocortisone (0.3 g/d) but symptoms did not improve, and the treatment was changed to oral methylprednisolone (0.6 g/d) and a hydrocortisone enema (0.1 g/late). Finally, the patient underwent a total colectomy and ileostomy. In case 2, the patient was treated with sulfasalazine, mesalazine, and intermittent hormone enemas. A total colectomy and ileostomy were performed with the patient after diagnosed as colon cancer. After surgery, the patient received N1-(2 tetrahydrofuryl)-5-fluorouracil (FT-207), 8 g, 300 mg, and 100 mg oxaliplatin chemotherapy, and biologic therapy.

Outcomes: In case 1, the patient presented with duodenal necrosis and died of septic shock. In case 2, the patient recovered well without recurrence by taking proton pump inhibitor.

Lessons: The occurrence of UC related ulcerative gastroduodenal mucosal lesions may be associated with progressing UC or total colitis that does not respond to hormone therapy, leading to requirement of total colectomy.

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Source
http://dx.doi.org/10.1097/MD.0000000000015035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456136PMC
April 2019
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