A 70-year-old male smoker with pulmonary emphysema was referred to our institution in May 2001 due to diarrhea, abdominal pain, general deterioration with weight loss, anemia and hypoalbuminemia.
Sepsis revealed a polypoid mass in the sigmoid colon that produced stenosis preventing the passage of the terminal.
Although biopsies did not confirm the malignancy of the lesion, resection was performed with laterolateral colonic anastomosis.
The report of the surgical specimen was: colectomy specimen with an extensive ulcer of 6.5 cm, with raised edges that penetrated the wall of the colon to the pericholic fat with extensive inflammatory reaction of mucus mucosa reparative inclusion level.
The diagnosis was: deep cystic colitis.
The patient improved after surgery but came six months later for pain and anal discharge.
A fistulous orifice was observed in the right anal margin with no clear inflammatory but painful signs at the touch with spontaneous exit of white fluid and an ulcer of the anal canal extending proximally.
The patient confirmed that the ulcer extended 3 cm in the rectum and had regular nodular borders.
In the colonic anastomosis another ulcer with pseudonodular formations and large amount of mucus was observed, and at 30 cm another mucosal exposition similar with a possible fistula orifice was observed.
Biopsies were nonspecific.
Upon admission, the patient developed septic arthritis and gastroscopy revealed severe distal colitis, erosive gastritis and diffuse ulceration of the mucosa of the bulbar and postbulbar duodenum.
Gastrin levels were determined as 817 pg/ml (normal value up to 100 pg/ml).
Biopsies of duodenal ulcers were also nonspecific.
Patient improved with 40 mg daily, ovate plant and analgesics.
Abdominal CT confirmed the presence of a 3 cm mass in vascularized pancreas coil-body.
Laparotomy was performed without finding pancreatic tumor and a mass in the transverse colon was resected.
The histological examination was: 21 cm of transverse colon with an area with irregular mucosa and aberrant aspect of 7 cm extension, areas of linear ulceration with inflammatory infiltrate with microabscesses affecting the whole piece.
At two months the gastrin value was 529 pg/ml.
The patient remained unattended and had new examinations and good general condition for 2 and a half years, having one or two stools a day formed with some anal incontinence, received iron due to ferropenic anemia, plantago ovata
In October 2004 a segmental colitis was performed due to diarrhea. It showed a segmental colitis ranging from 15 cm of anal margin to 35 cm with pseudopolyps and friability that impressed as ulcerative colitis.
The rectum showed no lesions.
Colon biopsies suggested active ulcerative colitis.
The patient was treated with oral tablelacin and then steroids from November 2004 to February 2005.
The patient was admitted several times due to worsening of his pulmonary emphysema and suffered a bilateral pneumothorax.
He was followed up only in pulmonology clinics until April 2006.
