Kongon Panutchaya, Tangsirapat Vorapatu, Ohmpornuwat Vittawat, Sumtong Kannakrit, Chakrapan Na Ayudhya Vichack, Chakrapan Na Ayudhya Kobkool, Sookpotarom Paiboon, Vejchapipat Paisarn
Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Int J Surg Case Rep. 2019;61:234-237. doi: 10.1016/j.ijscr.2019.07.008. Epub 2019 Jul 16.
Recognition of elderly-onset ulcerative colitis (UC) remains poor as the differential diagnosis in older patients with acute abdominal pain and bloody diarrhea is extensive and UC is generally not the obvious cause. A typical presentation in an elderly patient with acute severe UC can mimic surgical abdomen.
An 80-year-old female had been presented with high grade fever, abdominal pain and diarrhoea. Physical examination showed sign of peritonitis and severe hypotension. A provisional diagnosis of perforated sigmoid diverticulitis was made. However, at the theater, there was only turbid yellowish ascites at cal-de-sac. Consequently, colonoscopy was performed and revealed continuous and circumferential erythematous with friable mucosa and multiple shallow ulcer along upper left side colon. Histologic examination of the colonic tissue was consistent with UC.
As UC is uncommon in Thailand and clinical features of elderly-onset UC are much more non-specific; as a result, misdiagnosis at initial presentation is more common in elderly patients (60%) than that in younger population (15%). These might result in an unnecessary exploratory laparotomy; however, computed tomography scan can reduce the risk of that event.
The diagnosis of severe acute UC in elderly patients with acute abdomen had been complicated by the distinctive physiology of this aged group with atypical presentation and markedly unreliable physical examination. Eventually, severe UC should always be kept in mind with a circumstance of abdominal pain in geriatric population.
老年溃疡性结肠炎（UC）的识别率仍然很低，因为老年急性腹痛和血性腹泻患者的鉴别诊断范围广泛，UC通常不是明显病因。老年急性重症UC的典型表现可类似急腹症。
一名80岁女性出现高热、腹痛和腹泻。体格检查显示有腹膜炎体征和严重低血压。初步诊断为乙状结肠憩室炎穿孔。然而，在手术室中，盆腔仅见浑浊的淡黄色腹水。因此，进行了结肠镜检查，发现沿左上部结肠有连续性和环形红斑，黏膜易碎，并有多个浅溃疡。结肠组织的组织学检查符合UC。
由于UC在泰国并不常见，老年UC的临床特征更不具特异性；因此，老年患者初次就诊时的误诊（60%）比年轻人群（15%）更为常见。这可能导致不必要的剖腹探查；然而，计算机断层扫描可以降低这种情况的风险。
老年急腹症患者中重症急性UC的诊断因该年龄组独特的生理状况、非典型表现和明显不可靠的体格检查而变得复杂。最终，在老年人群出现腹痛的情况下，应始终考虑到重症UC。
