A Case of Ulcerative Colitis with Massive Bleeding from the Restative Rectum after Subtotal Colectomy

Ryutaro Mori, Kazutaka Koganei and Hiroshi Shimada*

Chronic Intractable Disease Center, Yokohama City University Medical Center
Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine*

We report a case of ulcerative colitis with massive bleeding from the residual rectum after subtotal colectomy. A 51-year-old woman diagnosed with ulcerative colitis 4 years ago but well controlled since was seen for recurrence accompanied by rectal bleeding, diarrhea, abdominal pain, and tenesmus. When treatment with 30 mg of predonisolone per day was not effective, she was admitted and was placed on an intensive intravenous regimen of predonisolone at a dosage of 50 mg per day. Gastrographine enema showed deep ulcers in the sigmoid colon and rectum. Ten days following therapy, her symptoms did not disappear, necessitating subtotal colectomy with ileostomy and suprapubic mucous fistula. On postoperative day 6, she bled massively from the residual rectum and suffered hypovolemic shock, necessitating emergency proctocolectomy with ileal pouch anal canal anastomosis and covering ileostomy was performed. The stetted rectum showed deep ulcers with much coagulation. Total proctocolectomy with ileal pouch anal canal anastomosis and ileostomy may thus be recommended in patients with continuous bleeding from deep rectal ulcers.

Key words
ulcerative colitis, massive bleeding, subtotal colectomy

Reprint requests
Ryutaro Mori Chronic Intractable Disease Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
November 30, 2004

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