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Inflammatory bowel diseases

An unusual colonoscopy appearance of ulcerative colitis (UC) in remission.

An unusual colonoscopy appearance of ulcerative colitis (UC) in remission

M.Blaszczynska, G.Thomas, AB. Hawthorne *, E.Youd, AM. Boyde** * Department of Gastroenterology, ** Department of Pathology University Hospital of Wales, Heath Park, Cardiff

There are a number of typical colonoscopy features of UC in remission. These range from a normal looking mucosa, to the findings of mucosal atrophy, erythema, loss of the normal vascular pattern, a lack of haustration, pseudopolyps, mucosal scarring and a relatively shortened bowel.

We present the case of a 47-year-old female, who has suffered from left-sided ulcerative colitis (UC) for 30 years. She had experienced periods of remission and relapse over the years, and when active had had mild to moderate symptoms. She had been maintained on long term mesalazine (400mg bd orally). Previous colonoscopy performed 7 years ago confirmed left-sided UC in remission with an oedematous mucosa, erythema and loss of vascular pattern.

On follow-up colonoscopy, in September 2008, some interesting changes were noted. In the left , extending from the splenic flexure to the mid descending colon, there were changes of extensive scarring (see photos). This had not caused narrowing of the lumen. There were a also a few pseudopolyps in the rectum. Several biopsies were taken. Histology reported fragments of large bowel mucosa showing mild distortion of crypt architecture, but no evidence of inflammation, dysplasia or malignancy. Biopsies taken from the polyps were consistent with inflammatory pseudopolyps.

The finding of some scarring of the colon is not uncommon in longstanding colitis, but to see such a dramatic and striking example is unusual. We hope our slides will be of interest to endoscopists in training.

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