Ulcerative colitis - pseudopolyps 2

This is a 37-year-old white female who has suffered from pancolitis for the last 12 years. After an initially very acute clinical course, she has experienced only a few flares in the last years. However, she has been repeatedly treated for iron deficiency anemia. The patient now appeared for a follow-up colonoscopy, because her last examination was 3 years ago.

The video begins in the terminal ileum with the endoscope passing through Bauhin’s valve into the cecum. The cecum exhibits a field of pseudopolyps of varying size. Bauhin’s valve is also affected making it less easily recognised. Some pseudopolyps have reached significant size and impinge at several places on the lumen. Between the pseudopolyps, there is little mucosa visible, with rarefied and irregular vasculature. Ulcerations are not seen. Endoscopically, this is disease in remission. 

This patient's disease was first diagnosed 12 years ago. Thus, careful work-up including stepped biopsies is required. Not only the flat mucosa between the pseudopolyps should be biopsied but also several larger polypoid lesions, since patients with ulcerative colitis are at risk for developing adenomas, which must be excised.