Medical Management of Ulcerative Colitis
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Medical Management of Ulcerative Colitis
Benign Disease- A patient with ulcerative colitis refractory to medical therapy undergoes total proctocolectomy. Which extraintestinal manifestation is most likely to persist after the colectomy?
- A 43-year-old man is seen on an inpatient consultation basis for ulcerative colitis that has been recalcitrant to medical management for the past 2 weeks. He has worsening abdominal pain, persistent diarrhea, rectal bleeding, and intermittent fevers. He was given empiric broad-spectrum antibiotics for elevated leukocytosis. Colonoscopy revealed pancolitis consistent with findings of ulcerative colitis. Although his pain improves, he continues to have 15 to 20 watery bowel movements per day. What is the most appropriate next step in management?
- A 28-year-old woman presents with pan-ulcerative colitis since age 16 years. Her symptoms were previously well-controlled with vedolizumab and mesalamine, but she has recently begun to experience frequent flares of disease. She is interested in having children and is referred for consideration of elective surgery involving a restorative proctocolectomy with an ileal pouch–anal anastomosis. What is the postsurgical effect on future childbearing about which you would counsel the patient?
- Perioperative
- Ulcerative Colitis: Surgical Management
Benign Disease- A 45-year-old man with intractable ulcerative colitis (UC) presents with a 6-month history of frequent bloody, loose bowel movements up to 15 times daily. He has significant urgency and anemia with a hemoglobin of 6.8 g/dL. He has had a 30-lb weight loss in the past 6 months, and his albumin level is 2.5 g/dL. He has been on infliximab and adalimumab in the past and is currently on vedolizumab and 40 mg/day of prednisone. What is the best next step in this patient’s management?
- 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 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?
- About ASCRS Textbook of Colon and Rectal Surgery
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