| Colonic ulcer | |
|---|---|
| Other names | Colon ulcer |
 | |
| Diameters of the large intestine | |
| Specialty | Gastroenterology |
Colonic ulcer can occur at any age, in children however they are rare. Most common symptoms are abdominal pain and hematochezia. [1]
| Colonic ulcer | |
|---|---|
| Other names | Colon ulcer |
| | |
| Diameters of the large intestine | |
| Specialty | Gastroenterology |
Colonic ulcer can occur at any age, in children however they are rare. Most common symptoms are abdominal pain and hematochezia. [1]
Colonic ulcers present differently depending on where and how much of the intestinal wall is affected. Patients may be asymptomatic or exhibit symptoms such as anemia, abdominal pain, hematochezia, chronic gastrointestinal bleeding, and perforation. [2]
Stercoral ulceration is a loss of bowel integrity caused by the pressure induced by inspissated feces. The lesion typically manifests as an isolated lesion in the rectosigmoid area in patients who are bedridden and constipated. Perforation and hemorrhage, the main complications, cause a mortality rate higher than 50% due to related diseases in the population at risk. If a patient has a history of constipation and presents with acute abdominal pain and clinical findings consistent with a hollow viscus perforation, the diagnosis of perforated stercoral ulceration should be taken into consideration. The treatment of choice is early celiotomy with aggressive debridement and irrigation of the peritoneal cavity, followed by either resection with proximal colostomy or exteriorization. [3]
Ulcerative colitis is a type of inflammatory bowel disease (IBD). [4] It is a long-term condition that results in inflammation and ulcers of the colon and rectum. [4] [5] The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer. [4] [6]
The cause of UC is unknown. Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors. [4] [7] Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or to a Western diet and lifestyle. [5] [8] Often it begins in people aged 15 to 30 years, or among those over 60. [4] Males and females appear to be affected in equal proportions. It has also become more common since the 1950s. [5] The removal of the appendix at an early age may be protective. [8] Diagnosis is typically by colonoscopy with tissue biopsies. [4]
Dietary changes, such as maintaining a high-calorie diet or lactose-free diet, may improve symptoms. Several medications are used to treat symptoms and bring about and maintain remission, including aminosalicylates such as mesalazine or sulfasalazine, steroids, immunosuppressants such as azathioprine, and biologic therapy. Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. Removal of the colon and rectum generally cures the condition. [4] [8]
Solitary rectal ulcer syndrome (SRUS) is a rare benign disease characterized by symptoms, clinical findings, and histological abnormalities. [9] Only 40% of patients have ulcers; 20% of patients have a single ulcer, and the remaining lesions range in size and form from broad-based polypoid to hyperemic mucosa. [10] Clinical signs and symptoms include rectal bleeding, copious mucus discharge, prolonged, severe straining, abdominal and perineal pain, constipation, and, in rare cases, rectal prolapse. [11] Histopathological features of this disease include fibrosis obliterating the lamina propria and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. [12] SRUS has been treated with a variety of methods, including conservative measures such as diet and bulking agents, medical therapy, biofeedback, and surgery. Treatment is determined by the severity of the symptoms and whether or not there is rectal prolapse. [13]
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications in the world, and their side effects primarily affect the gastrointestinal tract. Although uncommon, colonic involvement is widely known. [2] One study of 425 patients with chronic NSAID use found that 3% of the patients had colonic lesions. [14] Colonic injury is most frequently linked to longer-acting and enteric-coated NSAIDs; the most frequent reports of injury occur after using diclofenac and enteric-coated aspirin. [15] Rectal ulcers and colitis have also been linked to NSAID rectal suppositories. The length of drug use is less significant because patients who have taken the medication for several months to years have been reported to develop colonic ulcers. [2]
Although many infections involve the colon, only a few of them can cause isolated ulcers. [2]
Isolated colonic ulceration is a symptom of intestinal tuberculosis. Ulcers can occur anywhere in the colon, but they are most common on the right side. Usually transverse, the ulcers range in size from 1 to 3 cm. They have a deep base covered in exudate and are frequently accompanied by stricture or a nodule-like appearance around the edge. Biopsy specimens reveal epithelioid granulomas, crypt distortion, and acute and chronic inflammation. [16]
The colon is the primary site of amebiasis. Sometimes patients present with colon ulceration but no diffuse colitis. In patients who do not have acute diarrhea or colitis, ulcers are usually small, single or multiple, with well-defined margins, more often in the right colon, and surrounded by normal mucosa. [17]
Strongyloidiasis is found in the tropics and southeastern United States. The majority of patients have abdominal pain as well as significant peripheral eosinophilia. The small bowel is the most commonly affected. Colonic involvement can cause multiple shallow serpiginous ulcers, erythema, and friability. Inflammation and Strongyloides eggs are discovered during a biopsy. Treatment with ivermectin or thiabendazole has shown efficacy. [18]
Up to 25% of Behçet's syndrome patients have gastrointestinal involvement, with ulceration in the ileocolic region being the most common gastrointestinal site. Colonic ulcers are most commonly found in the cecum. Typically, the ulcers are large, round to oval, solitary, relatively deep, and have an undermining edge. [19]
In rare cases, radiotherapy for prostate cancer can result in a non-healing rectal ulcer. A fistula may exacerbate these ulcers, necessitating surgical intervention. Biopsies should be taken to rule out cancer. [20]
Rarely, iron-deficiency anemia can result from ulcers that form at the location of the ileocolonic anastomosis in the absence of inflammatory bowel disease. The cause of the ulceration is unknown, but it is most likely due to local ischemia or NSAID use, which should be avoided. Oral iron replacement therapy can be used to treat the majority of patients. [21]
The diagnosis of a patient with isolated large bowel ulceration is based on their presenting symptoms, endoscopic appearance, and the histology of the lesion. Particularly in cases of rectal ulcers, biopsies from the ulcer's margins should be obtained in order to rule out malignancy. Random biopsies of the normal colon mucosa may be taken in patients who have diarrhea or who have a high suspicion of having inflammatory bowel disease. [2]
In terms of management cessation of NSAIDs, and management of constipation are important [2]
Crohn's disease is a chronic inflammatory bowel disease characterized by recurrent episodes of intestinal inflammation, primarily manifesting as diarrhea and abdominal pain. Unlike ulcerative colitis, inflammation can occur anywhere in the gastrointestinal tract, though it most frequently affects the ileum and colon, involving all layers of the intestinal wall. Symptoms may be non-specific and progress gradually, often delaying diagnosis. About one-third of patients have colonic disease, another third have ileocolic disease, and the remaining third have isolated ileal disease. Systemic symptoms such as chronic fatigue, weight loss, and low-grade fevers are common. Organs such as the skin and joints can also be affected. Complications can include bowel obstructions, fistulas, nutrition problems, and an increased risk of intestinal cancers.
Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.
Hematochezia is a form of blood in stool, in which fresh blood passes through the anus while defecating. It differs from melena, which commonly refers to blood in stool originating from upper gastrointestinal bleeding (UGIB). The term derives from Greek αἷμα ("blood") and χέζειν. Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper gastrointestinal bleed. The difference between hematochezia and rectorrhagia is that rectal bleeding is not associated with defecation; instead, it is associated with expulsion of fresh bright red blood without stools. The phrase bright red blood per rectum is associated with hematochezia and rectorrhagia.
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.
Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum; and the accessory organs of digestion, the liver, gallbladder, and pancreas.
Diverticular disease is when problems occur due to diverticulosis, a benign condition defined by the formation of pouches (diverticula) from weak spots in the wall of the large intestine. This disease spectrum includes diverticulitis, symptomatic uncomplicated diverticular disease (SUDD), and segmental colitis associated with diverticulosis (SCAD). The most common symptoms across the disease spectrum are abdominal pain and bowel habit changes such as diarrhea or constipation. Otherwise, diverticulitis presents with systemic symptoms such as fever and elevated white blood cell count whereas SUDD and SCAD do not. Treatment ranges from conservative bowel rest to medications such as antibiotics, antispasmodics, acetaminophen, mesalamine, rifaximin, and corticosteroids depending on the specific conditions.
Colectomy is the surgical removal of any extent of the colon, the longest portion of the large bowel. Colectomy may be performed for prophylactic, curative, or palliative reasons. Indications include cancer, infection, infarction, perforation, and impaired function of the colon. Colectomy may be performed open, laparoscopically, or robotically. Following removal of the bowel segment, the surgeon may restore continuity of the bowel or create a colostomy. Partial or subtotal colectomy refers to removing a portion of the colon, while total colectomy involves the removal of the entire colon. Complications of colectomy include anastomotic leak, bleeding, infection, and damage to surrounding structures.
Proctitis or anusitis is an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum.
Blood in stool looks different depending on how early it enters the digestive tract—and thus how much digestive action it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleeding; or to hematochezia, with a red color, typically originating from lower gastrointestinal bleeding. Evaluation of the blood found in stool depends on its characteristics, in terms of color, quantity and other features, which can point to its source, however, more serious conditions can present with a mixed picture, or with the form of bleeding that is found in another section of the tract. The term "blood in stool" is usually only used to describe visible blood, and not fecal occult blood, which is found only after physical examination and chemical laboratory testing.
Lower gastrointestinal bleeding (LGIB) is any form of gastrointestinal bleeding in the lower gastrointestinal tract. LGIB is a common reason for seeking medical attention at a hospital's emergency department. LGIB accounts for 30–40% of all gastrointestinal bleeding and is less common than upper gastrointestinal bleeding (UGIB). It is estimated that UGIB accounts for 100–200 per 100,000 cases versus 20–27 per 100,000 cases for LGIB. Approximately 85% of lower gastrointestinal bleeding involves the large intestine, 10% are from bleeds that are actually upper gastrointestinal bleeds, and 3–5% involve the small intestine.
Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply (ischemia). Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia. Causes of the reduced blood flow can include changes in the systemic circulation or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.
In the anatomy of humans and homologous primates, the descending colon is the part of the colon extending from the left colic flexure to the level of the iliac crest. The function of the descending colon in the digestive system is to store the remains of digested food that will be emptied into the rectum.
Proctocolectomy is the surgical removal of the entire colon and rectum from the human body, leaving the patients small intestine disconnected from their anus. It is a major surgery that is performed by colorectal surgeons, however some portions of the surgery, specifically the colectomy may be performed by general surgeons. It was first performed in 1978 and since that time, medical advancements have led to the surgery being less invasive with great improvements in patient outcomes. The procedure is most commonly indicated for severe forms of inflammatory bowel disease such as ulcerative colitis and Crohn's disease. It is also the treatment of choice for patients with familial adenomatous polyposis.
Stercoral ulcer is an ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation due to a large bowel obstruction, damage to the autonomic nervous system, or stercoral colitis. It is most commonly located in the sigmoid colon and rectum. Prolonged constipation leads to production of fecaliths, leading to possible progression into a fecaloma. These hard lumps irritate the rectum and lead to the formation of these ulcers. It results in fresh bleeding per rectum. These ulcers may be seen on imaging, such as a CT scan but are more commonly identified using endoscopy, usually a colonoscopy. Treatment modalities can include both surgical and non-surgical techniques.
Pancolitis or universal colitis, in its most general sense, refers to inflammation of the entire large intestine comprising the cecum, ascending, transverse, descending, sigmoid colon and rectum. It can be caused by a variety of things such as inflammatory bowel disease, more specifically a severe form of ulcerative colitis. A diagnosis can be made using a number of techniques but the most accurate method is direct visualization via a colonoscopy. Symptoms are similar to those of ulcerative colitis but more severe and affect the entire large intestine. Patients generally exhibit symptoms including rectal bleeding as a result of ulcers, pain in the abdominal region, inflammation in varying degrees, and diarrhea, fatigue, fever, and night sweats. Due to the loss of function in the large intestine patients may lose large amounts of weight from being unable to procure nutrients from food. In other cases the blood loss from ulcers can result in anemia which can be treated with iron supplements. Additionally, due to the chronic nature of most cases of pancolitis, patients have a higher chance of developing colorectal cancer.
Cytomegalovirus colitis is an inflammation of the colon.
Rectal discharge is intermittent or continuous expression of liquid from the anus. Normal rectal mucus is needed for proper excretion of waste. Otherwise, this is closely related to types of fecal incontinence but the term rectal discharge does not necessarily imply degrees of incontinence. Types of fecal incontinence that produce a liquid leakage could be thought of as a type of rectal discharge.
Solitary rectal ulcer syndrome or SRUS is a chronic disorder of the rectal mucosa. It commonly occurs with varying degrees of rectal prolapse. The condition is thought to be caused by different factors, such as long term constipation, straining during defecation, and dyssynergic defecation. Treatment is by normalization of bowel habits, biofeedback, and other conservative measures. In more severe cases various surgical procedures may be indicated. The condition is relatively rare, affecting approximately 1 in 100,000 people per year. It affects mainly adults aged 30–50. Females are affected slightly more often than males. The disorder can be confused clinically with rectal cancer or other conditions such as inflammatory bowel disease, even when a biopsy is done.
Segmental colitis associated with diverticulosis (SCAD) is a condition characterized by localized inflammation in the colon, which spares the rectum and is associated with multiple sac-like protrusions or pouches in the wall of the colon (diverticulosis). Unlike diverticulitis, SCAD involves inflammation of the colon between diverticula, while sparing the diverticular orifices. SCAD may lead to abdominal pain, especially in the left lower quadrant, intermittent rectal bleeding and chronic diarrhea.
A rectal stricture is a chronic and abnormal narrowing or constriction of the lumen of the rectum which presents a partial or complete obstruction to the movement of bowel contents. A rectal stricture is located deeper inside the body compared to an anal stricture. Sometimes other terms with wider meaning are used, such as anorectal stricture, colorectal stricture or rectosigmoid stricture.
