Ulcerative colitis - remission 3
This 37-year-old white female has suffered from ulcerative colitis for the past 15 years, with her disease being in remission for the last 4 years. The patient is still taking 5-aminosalicylic acid. Her only symptom are 3-4 loose stools per day. No blood or mucus is reported. Today's examination is a scheduled colonoscopy in a patient with long-term disease.
The video starts deep in the terminal ileum. The vili appear flat and there are only a few vessels visible. Especially in the vicinity of Bauhin’s valve the reflected light is refracted and the mucosa appears granular to bumpy. These changes are due to backwash ileitis, which is now in remission. Bauhin’s valve itself is gaping open and does not close during the examination. An open Bauhin’s valve is often seen in association with backwash ileitis. The cecum is completely flat and without haustration. There is loss of haustration in the entire colon, which has the appearance of a stiff tube. Vessels are visible but they are small and show small branches. Such vessels are frequently seen in patients with ulcerative colitis in remission. In general, the mucosa is smooth. There are, however, a few pseudopolyps, of which one in the sigmoid colon measured about 2 cm in diameter and appears soft when touched by the biopsy forceps. The bowel lumen is somewhat narrowed in this area.
Patients with findings such as these, especially if the duration of the disease has been long, require stepped biopsies. The discrete narrowing of the sigmoid colon deserved especial attention. Even if histology shows benign changes, further work-up, including ultrasound or CT, should be considered.
(see also commentary to example 1 und example 2)