Colitis ulcerosa - active 2
This is a 21-year-old female student diagnosed three years earlier with distal ulcerative colitis. During these three years, symptoms never subsided completely and patient experienced recurrent episodes of bloody diarrhea. Disease involvement was limited to the rectum and distal sigmoid colon. She was treated with oral 5-aminosalicylic acid and local application of budesonide. Multiple disease flares were treated with prednisolone.<br />Over the past few weeks, stool frequency increased to 30 thin, bloody stools per day. The patient appeared pale and tachycardic. Ultrasound revealed spread of the disease to the entire colon with mural thickening and hypervascularization
The video clip begins in the rectum. The mucosa is edematous and swollen with numerous small ulcerations and fibrinous-purulent deposits. Vascular structures are not recognizable. The mucosa is very vulnerable to injury upon contact with the endoscope. The endoscope is carefully advanced with limited insufflation as far as the transition to the descending colon. The mucosa presents a uniform appearance.
History, clinical findings and ultrasonography demonstrate the proximal spread of disease involvement with severe disease-related changes. In this case, high colonoscopy is both risky and unnecessary. For this reason, examination was interrupted in the sigmoid colon and an intense pharmacological therapy was started.