Colitis ulcerosa - chronic active 4
This 56-year-old white male has had ulcerative colitis for 15 years and has experienced recurrent flares with involvement of the entire colon and the terminal ileum. Early in the disease, only the sigmoid and descending colon were involved. For the last 10 years, there has been pancolitis and for the last 4 years there has been involvement of the terminal ileum with inflammatory changes and gaping Bauhin’s valve. The patient has now come to a scheduled follow-up colonoscopy. The clinical picture is significant for iron deficiency anemia and 5 watery stools per day. The patient does not report macroscopically visible blood admixture.
The video begins in the terminal ileum. The mucosal surface is somewhat irregular. There are no ulcerations. Few vessels are visible. Bauhin’s valve is gaping open and appears stiff. Such changes are often associated with backwash ileitis. The cecum and ascending colon exhibit polypoid changes of the mucosa with bizarre ulcerations. The opening of the appendix appears stiff. In the ascending colon, there is a similar picture with some confluent ulcerations and larger pseudopolyps.
The duration of the disease and the endoscopic findings mean that a careful histological examination with stepped biopsies is essential, since the patient is at increased risk of developing malignant changes.
(see also commentary to example 1, example 2 und example 3).