A 50-year-old male, with no history of interest, drinker of 60 g ethanol/ and smoker of 30 packs/year, was admitted for study for anorexia nervosa and recurrent weight loss of 6 kg per day.
She had a bowel habit of four stools a day with normal characteristics.
There is no other associated clinic.
The physical examination revealed a 3 cm hepatomegaly without rectal mass. The left hepatic lobe was not painful, the blister was closed and an umbilical hernia was reduced without complications. The anal inspection showed a scar of a rectal abscess.
The rest of the examination was normal.
Analytically, the patient had mild normocytic normochromic anemia (hemoglobin 12.8 g/dl) with rest of blood count and normal coagulation, total coagulation of calcium, bilirubin (glycosides, amylase, mil U/albumin), glycosylated total acid glycoprotein 154
VSG 60 mm/h; CEA 11.1 ng/ml; CA 19.9 23.8 U/ml; and PSA 4.95 ng/ml.
AFP and beta-2-microglobulin are normal.
Analytical study of liver disease is normal: iron, alpha-1-antitrypsin, ceruloplasmin, serology viral hepatitis, HIV, syphilis, serology herpes group virus (IgM), immunoglobulins
Proteinogram with albumin 3.1 g/dl, alpha 2 0.9 g/dl, gamma 1.9 g/dl, alpha1 and beta normal.
Thyroid hormones are normal.
Urine E and S is normal.
Bence-Jones proteinuria is negative.
The chest X-ray is also normal.
Coprocultives are negative.
A gastrointestinal transit is performed visualizing a small hernia of sliding hiatus with gastroesophageal reflux, the rest of the examination being normal.
Abdominal ultrasound only shows an enlarged liver and echogenicity.
A CAT scan was also performed, observing enlargement of the liver, especially of the left liver lobe and repermeabilization of the paraumbilicals, thickening of the segmental wall of the left colon descending colonic fistula, transverse hernia, diverticulum.
Length and length discrepancy with ileo-ileal angle (two times) were found: in small rectal ampulla, there were diverticula in the midline, there were diverticula in the small intestine, and in the broad intestine.
Several inconclusive biopsies are taken, and finally several macrobiopsies, which are sent to microbiology, with conventional culture and Actinomyces negative, and to histopathology, confirming the diagnosis of colitis.
Neither endoscopic ultrasound nor intraoperative transanal biopsy could be performed due to the location of the lesions.
Since admission, the patient continues with his usual intestinal rhythm and has been assessed by general surgery 4 months after discharge due to a new recurrence of the perianal abscess.
During follow-up, laboratory tests and outpatient endoscopic changes were not observed.
