PMC4011670_01
Results of colonoscopy. Multiple punched-out ulcers and multiple aphthous ulcers on the sigmoid colon on April 4, 2000 (A), and on the ascending colon on April 18, 2000 (B).
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However, on day 6, the bloody stool recurred suddenly, with multiple punched-out ulcers and bleeding from the rectum to the sigmoid colon revealed by proctoscopy (Figs. 2A, 4). An emergency colonoscopy examination (Fig. 2B) revealed colorectal inflammation from the terminal ileum to the rectum, particularly in the ascending colon area, showing multiple punched-out ulcers and bleeding in their bases.
X-ray and CT of the sacroiliac joint and the lumbar spine. There was no lesion of sacroiliitis or of spondylitis on July, 2000 (A), or June 1, 2007 (B).
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Radiologic examinations such as X-ray and computed tomography (CT) of his joints showed no abnormalities, especially for the spine, iliosacral joints, and enthesopathy (Fig. 3).
Microscopic findings of sigmoid colon biopsy: in a low-power field (A) and in a high-power field (B).
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However, on day 6, the bloody stool recurred suddenly, with multiple punched-out ulcers and bleeding from the rectum to the sigmoid colon revealed by proctoscopy (Figs. 2A, 4). Biopsies of the sigmoid colon (Fig. 4) and rectum showed erosions and marked inflammatory cell infiltration in the lamina superficial epithelium with regeneration and crypts. Biopsy findings of the ileum and ascending colon on day 20 were similar to those of the sigmoid colon and rectum on day 6 (Fig. 4).
Findings of the resected colon: macroscopic findings of the whole area (A) and the region of colon ulcers (B) and microscopic findings of the colon ulcer in a low-power field (C) and in a high-power field (D).
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Thus, total colectomy (Fig. 5A), including terminal ileum and ileostomy, were conducted on day 70 (June 6). The findings of his resected colon (Fig. 5) were as follows: in the whole 130 cm length from the terminal ileum to rectum (Fig. 5A), subcutaneous abscesses with necrotic tissue adhesions were found throughout, although microbiological and serological examinations of samples from those abscesses revealed no findings, and inflammation was absent from the serous coat of the large intestine. Ul-3 with sharp edges were found throughout the colon (Fig. 5B); irregular oval ulcers were seen from the ascending colon to the sigmoid colon, with one in the descending colon being 5 cm in longitudinal length with perforation. Ulcer scars were seen diffusely in the sigmoid colon and the rectum, suggesting similar ulcers from the ascending colon to the sigmoid colon; fibrosis was seen in the periulcer submucosa (Fig. 5C). Neither extension nor reduction in the muscularis propria, atrophic granuloma suspicious of Crohn's disease, vasculitis, ischemic changes, infection, or dysplasia suggesting malignancy were seen; diffuse inflammatory cell infiltrates were found in the nonperforated regions with fissures through the fascia (Fig. 5D).