Ulcerative colitis - active 1
Author: Prof. em. Dr. med. S. Liebe, University Hospital Rostock, Rostock, Germany
From: Falk Media Service D34, Endoscopy Practice on Video - Selected Diseases of the Colon
2. Edition 2012. © Falk Foundation e.V. All rights reserved.
This is a 20-year-old white male, who suddenly became ill with fever and diarrhea mixed with mucus and blood.
Laboratory findings included microcytic anemia.
The video begins in the terminal ileum with normal mucosa. Vascular structures are clearly visible. Immediately distal to Bauhin’s valve, there is the abrupt appearance of florid ulcerative colitis affecting the cecum, which extends in similar severity throughout the entire colon. Vascular structure is lost. There are whitish deposits consisting of fibrin and pus, with small ulcerations, increased vulnerability and oedema of the mucosa with spontaneous bleeding. Haustrations are preserved. The mucosal surface appears granulated and there is refraction of the reflected light.
Ulcerative colitis spreads through the colon from the distal to the proximal end. The rectum is affected in practically all cases. Bauhin’s valve normally forms a natural boundary for the disease. The activity of the inflammation usually decreases from distal to proximal segments. Mucosal oedema with loss of vascular structure and increased mucus production are early signs of ulcerative colitis. Deposits of mucus and pus, increased vulnerability and ulcerations are signs of florid disease.
Colonoscopy can be performed with adequate caution in patients with the level of disease activity seen in this video. Insufflation should be kept to a minimum and intermittently aspirated.