Clinical features and treatment of ulcerative colitis-related severe gastroduodenitis and enteritis with massive bleeding after colectomy

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• 作者：Motoi Uchino (1) (2)
  Hiroki Matsuoka (1) (2)
  Toshihiro Bando (1) (2)
  Akihiro Hirata (1) (2)
  Hirofumi Sasaki (1) (2)
  Kei Hirose (1) (2)
  Yoshio Takesue (3)
  Shiro Nakamura (2) (4)
  Naohiro Tomita (1)
  Hiroki Ikeuchi (1) (2)
  
• 关键词：Ulcerative colitis ; Gastroduodenitis ; Enteritis ; Infliximab ; Cytomegalo ; virus
• 刊名：International Journal of Colorectal Disease
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：29
• 期：2
• 页码：239-245
• 全文大小：453 KB
• 作者单位：Motoi Uchino (1) (2)
  Hiroki Matsuoka (1) (2)
  Toshihiro Bando (1) (2)
  Akihiro Hirata (1) (2)
  Hirofumi Sasaki (1) (2)
  Kei Hirose (1) (2)
  Yoshio Takesue (3)
  Shiro Nakamura (2) (4)
  Naohiro Tomita (1)
  Hiroki Ikeuchi (1) (2)
  
  1. Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
  2. Inflammatory Bowel Disease Center, Hyogo, Japan
  3. Division of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan
  4. Department of internal medicine, Division of Lower Gastroenterology, Hyogo College of Medicine, Hyogo, Japan
  
• ISSN：1432-1262

文摘

Introduction Ulcerative colitis (UC) has been recognised as a systemic immune disorder that is not as restricted as colitis. UC-related gastrointestinal lesions with bleeding can develop soon after colectomy and can progress rapidly. Therefore, we considered the clinical features and treatment of these UC-related lesions. Methods We reviewed the patient data in our UC surgery database to evaluate its prevalence and features. Results We found 7/1,100 patients with UC-related lesions between January 2000 and April 2013. These lesions developed at a mean of 24 (range 8-80) days after colectomy. Six of the seven patients suffered from gastrointestinal bleeding as an initial symptom that rapidly developed into massive bleeding or perforations. All of the patients were diagnosed with pancolitis; at the time of colectomy, fulminant, severe, moderate, and mild colitis were presented by four, one, one, and one patients, respectively. All patients with enteritis had consecutively developed other infectious complications, including anastomotic leakage, pyoderma gangrenosum, wound infection, and pneumonia. Although patients with bleeding did not respond to treatment with corticosteroids, they responded well to infliximab soon after its administration. Although six of the seven patients showed cytomegalo virus re-activation in blood or pathological examinations, ganciclovir was not effective in its elimination. Conclusion Although UC-related lesions with an unknown aetiology can occur after colectomy, immediate examination and treatment are required if gastrointestinal bleeding is found after surgery. Because gastrointestinal bleeding from UC-related lesions can worsen rapidly and may be related to mortality, early potent immunosuppressive therapy should be considered.