Ulcerative Colitis: Surgical Management [sounds like]
10 results
1 - 10
Benign Disease- A 29-year-old patient with prior history of a total colectomy and end ileostomy for fulminant ulcerative colitis presents with peristomal skin irritation and difficulty with leakage around the stoma. Painful, ulcerated purple nodules with violaceous borders are seen around the stoma site, as shown in the image below. Biopsy of the lesion shows neutrophil infiltration and perivascular lymphocytic infiltration and no infection. What is the best next step in management for this patient?
- A 45-year-old man has an 8-year history of moderate-to-severe chronic ulcerative colitis (UC), managed with biologics and with good symptom control. He has no other notable medical or surgical history. His last colonoscopy was performed 1 year ago, with random biopsies demonstrating low-grade dysplasia. The patient is concerned about the development of colorectal cancer due to his history and is here for surveillance endoscopy. What is the best next step in this patient’s management?
- A 37-year-old man with a history of ulcerative colitis (UC) presents after a recent colonoscopy. Clinically and endoscopically, he has no evidence of active disease. He has been on oral mesalamine and 10 mg of prednisone for 6 months. Attempts to wean prednisone below 10 mg result in symptoms including passing of bloody diarrhea and abdominal pain. Which of the following is the best next step in his management?
- A 21-year-old man with a diagnosis of ulcerative colitis 1 year ago presents to the emergency department with abdominal pain, profuse diarrhea, and bloating. Flexible sigmoidoscopy 3 weeks ago demonstrated Mayo score of 3 for proctocolitis, after which he was started on oral prednisone 40 mg daily. Clostridium difficile testing was negative. He has made no improvement. He has lost 10 lbs in the past 2 weeks. His vital signs on presentation are: temperature 38.7 °C, heart rate 140 beats per minute, blood pressure 80/50 mmHg, and spO2 of 94% on room air. He is uncomfortable and pale with a mildly distended abdomen. His abdominal X-ray is shown below. His laboratory work demonstrates: normal range electrolytes, blood urea nitrogen (BUN) of 25 mg/dL, creatinine 1.1 mg/dL, white blood cell count of 25,000, hemoglobin (Hgb) 8.0 g/dL, hematocrit 24%, and platelet count of 370,000. What is the best next step in his care?
- A 55-year-old man with a history of ulcerative colitis (UC) diagnosed in his early 20s presents with a new diagnosis of distal rectal moderately differentiated adenocarcinoma. Mismatch repair (MMR) protein expression is intact; routine surveillance endoscopy showed a mass starting ~2 cm from the anal verge with all other biopsies negative for dysplasia. Laboratory results reveal unremarkable levels of carcinoembryonic antigen (CEA), comprehensive metabolic panel (CMP), and complete blood count (CBC). Systemic staging is negative for metastatic disease. Local staging with magnetic resonance imaging (MRI) reveals a T3N1 lesion. Based on a multidisciplinary tumor board discussion, the patient is planned for total neoadjuvant chemotherapy with upfront chemoradiation followed by consolidation chemotherapy. After this therapy is completed, what is the optimal surgical course for this patient?
- A 22-year-old woman with medically refractory ulcerative colitis presents for consideration of total abdominal proctocolectomy with ileal pouch-anal anastomosis (IPAA). Which of the following should be part of her preoperative evaluation?
- A 48-year-old man with a history of ulcerative colitis (UC) underwent the closure of a diverting ileostomy following an open restorative proctocolectomy with the creation of a J-pouch. Three weeks following stoma closure, he develops enteric drainage from his midline surgical-site, and computed tomography (CT) demonstrates a fistula tract from the tip of the J pouch. This drainage persists after an additional 4 weeks of observation. What is the most appropriate next step in management for this patient?
- A 65-year-old male patient with chronic cirrhosis due to primary sclerosing cholangitis underwent a subtotal colectomy and end ileostomy for refractory ulcerative colitis (UC) 2 years ago. He presents to the emergency department for uncontrolled bleeding from his ileostomy at the mucocutaneous junction. What is the best definitive treatment for this bleeding?
- A 50-year-old man with a 15-year history of ulcerative colitis (UC) is undergoing a surveillance colonoscopy. You find mild active colitis from the rectum to the splenic flexure, normal colon proximally, and a small 5-mm inflammatory polyp in the sigmoid colon. What is the recommended next step to take at this time?
- A 24-year-old man with history of ulcerative colitis (UC) is 3 days status postemergent subtotal colectomy with end ileostomy for toxic megacolon. He has a low-grade fever of 38.0 °C, rising heart rate to the 110s, rising leukocytosis to 15 x 109, and lower pelvic pain and pressure. Computed tomography (CT) of the abdomen and pelvis demonstrates abscess with fluid and gas adjacent and superior to the rectal stump staple line. How could the chance of complication have been reduced?