Ikeda Atsuyo, Mizushima Tsunekazu, Egashira Yutaro, Takahashi Hidekazu, Miyoshi Norikatsu, Haraguchi Naotsugu, Hata Taishi, Matsuda Chu, Doki Yuichiro, Mori Masaki
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
Department of Therapeutics for Inflammatory Bowel Disease, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
Clin J Gastroenterol. 2018 Feb;11(1):42-47. doi: 10.1007/s12328-017-0801-9. Epub 2017 Nov 21.
Diverticular colitis is chronic inflammation of the colon where diverticula are present. The endoscopic and histopathological findings of this disease are sometimes similar to those of ulcerative colitis, and several reports describe cases of diverticular colitis that progressed to typical ulcerative colitis. A 77-year-old woman with intramesenteric penetration of the sigmoid diverticulum underwent low anterior resection. One month later, the patient experienced anastomotic leakage, and transverse colostomy was performed. Six months after the colostomy, the patient returned to the hospital with complaints of bloody discharge from the rectum and stoma. Colonoscopy revealed newly developed loss of vascular pattern and a granular appearance of the mucosa in the rectum that had not been present at prior examinations. She was diagnosed with ulcerative colitis, which developed after colectomy, and treated with mesalazine and high-dose prednisolone, but the clinical and endoscopic response was poor. Finally, the patient underwent total proctocolectomy and ileal pouch anal anastomosis with diverting ileostomy. As a few reports have described, diverticular colitis can progress to typical ulcerative colitis after surgery in some cases, suggesting a possible pathogenic similarity between the two diseases and association between colorectal surgery and disease progression.
憩室性结肠炎是指存在憩室的结肠发生的慢性炎症。该疾病的内镜和组织病理学表现有时与溃疡性结肠炎相似，并且有几份报告描述了憩室性结肠炎进展为典型溃疡性结肠炎的病例。一名77岁女性因乙状结肠憩室肠系膜内穿孔接受了低位前切除术。术后1个月，患者出现吻合口漏，并进行了横结肠造口术。结肠造口术后6个月，患者因直肠和造口有血性分泌物而再次入院。结肠镜检查显示，直肠出现了新的血管纹理消失和黏膜颗粒样外观，而之前的检查中并未出现。她被诊断为结肠切除术后发生的溃疡性结肠炎，并接受了美沙拉嗪和大剂量泼尼松龙治疗，但临床和内镜反应不佳。最后，患者接受了全直肠结肠切除术和回肠贮袋肛管吻合术并进行了转流性回肠造口术。正如一些报告所述，憩室性结肠炎在某些情况下术后可进展为典型的溃疡性结肠炎，这表明两种疾病可能存在致病相似性，以及结直肠手术与疾病进展之间的关联。
