Case of the day

Ulcerative Colitis with Colon Stricture ? Etiology

A male aged 35 years who is a k/c/o IBD/UC on treatment Chief Complaints Pain Abdomen Anorexia Increased stool frequency (x1 month) Vitals BP- 106/60 mmHg PR- 102/min Investigations Colonoscopy- In distal descending colon, there was no further lumen and scope was not negotiable. Diagnosis What could be the cause and treatment approach

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As Ulcerative colitis is a PRE - MALIGNANT CONDITION- if a stricture is there in an established case of Ulcerative colotis- malignancy should be excluded first by a biopsy. followed by a CECT abdomen If biopsy is normal - then plan for surgery and excision of stricture. Other possibilities could be tuberculosis

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Obstruction in a case of ulcerative colitis It can be because of dysplasia leading to malignant transformation causing structure need to be high on list Other causes such as tuberculosis, diverticulitis etc are differential diagnosis Biopsy from mucosa around the structure will give more information

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The differentials for this patient are - Colonic stricture d/t UC - Development of malignancy - Crohn's colitis previously diagnosed as UC Do a biopsy from the stricture site and a CT enterography

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In long standing case of ulcerative colitis chances of developing malignancy is a known complication This Stricture may be benign/malignant. It can be differentiated by Biopsy. If malignancy management will depend upon staging of tumour. If benign varios options like Balloon dilatation, stricturoplasty, Excision of sticture are available.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Ulcerative colitis leading to stricture is not uncommon due to long standing . This is probably due to thickening and hypertrophy of the muscularis mucosa without any fibrosis. There may be benign and malignant strictures of colon is found , there are three distinctive features of malignanat strictures from benign ulcer a. There are lon standing history in case of malignant structure b. The more nearer to splenic flexure more chance of malignant structure about 60% as it goes down chance of malignancy lower as approaches sigmoid colon and chance of malignant further lowering as approaches to rectum c. Large gut obstruction is almost 100% in case if malignant stricture.

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D/d 1 submucosal fibrosis leading to colonic strictue 2 malignancy

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Take biopsy Get cect abdomen done

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Stenosis MRI with contrast Surrgery

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