A 70-year-old male smoker with pulmonary emphysema and vitiligo underwent colonoscopy in May 2001 due to diarrhoea, abdominal pain, general deterioration with weight loss, anaemia and hypoalbuminaemia. The colonoscopy showed a polypoid mass in the sigma that produced stenosis preventing the passage of the endoscope. Although biopsies did not confirm the malignancy of the lesion, resection was performed with latero-lateral colonic anastomosis. The report of the surgical specimen was: colectomy specimen with an extensive ulcer of 6.5 cm, with raised edges penetrating the colon wall down to the pericolic fat with extensive reparative inflammatory reaction and mucosal inclusions with hyperproduction of mucus forming lakes at the mural level within the ulcer. The diagnosis was: deep cystic colitis. The patient improved after surgery but returned six months later with anal pain and discharge. There was a fistulous orifice in the right anal margin with no clear inflammatory signs but painful to the touch with spontaneous discharge of white fluid and an ulcer of the anal canal extending proximally.
Colonoscopy confirmed that the ulcer extended 3 cm into the rectum, with regular and nodular borders. At the colonic anastomosis there was another ulceration with pseudonodular formations and a large amount of mucus, and at 30 cm there was another similar mucosal excavation with a possible fistulous orifice. Biopsies were non-specific. During admission he presented haematemesis and gastroscopy showed severe distal oesophagitis, erosive gastritis and diffuse ulceration of the mucosa of the bulbar and postbulbar duodenum. A gastrin determination was requested and was: 817 pg/ml (normal value up to 100 pg/ml). Biopsies of the duodenal ulcers were also non-specific. The patient improved with omeprazole 40 mg per day, plantago ovata and analgesics. A CT scan of the abdomen confirmed the presence of a 3 cm mass in a vascularised pancreatic tail-body. A laparotomy was performed and no pancreatic tumour was found, but a mass in the transverse colon was resected. Histological examination showed: 21 cm of transverse colon with an irregular mucosal area with a variegated aspect of 7 cm in extension, areas of linear ulceration with inflammatory infiltrate with microabscesses affecting the entire thickness of the piece. At two months the gastrin value was 529 pg/ml.
The patient did not agree to further examinations and remained in good general condition for two and a half years, having one or two bowel movements a day with some anal incontinence. He received iron due to iron deficiency anaemia, plantago ovata and omeprazole 20 mg a day. In October 2004 a colonoscopy was performed for diarrhoea which showed segmental colitis from 15 cm anal margin to 35 cm with pseudopolyps and friability, which looked like ulcerative colitis. The rectum was free of lesions. Colon biopsies suggested active ulcerative colitis. The patient was treated with oral mesalazine and then steroids from November 2004 to February 2005. The patient was admitted several times for worsening pulmonary emphysema and suffered a bilateral pneumothorax. He was followed up only in pulmonology consultations until April 2006.

