Sigmoid Colon Infection

Colon Infection

d, e Acute ulcerative colitis of uncertain genesis; presumed cytomegalovirus infection was ruled out. Colon ulcer with adherent clot (d). Visible vessel was seen after irrigation and removal of the clot and was closed with a hemoclip (Olympus) (e).

f Mild, acute hemorrhagic colitis in left hemicolon. No pathogen isolated.

CT C

t5 c

TO U

Hemorrhagic Colitis

g, h Acute colitis with hemorrhagic erosions (g) and submucosal hemorrhages (h). No pathogen detected.

Acute colitis with massive mucosal edema, isolated hemorrhaging, and small, erosive defects in a 64-year-old patient who was treated with immunosuppressants following a kidney transplant. Cytomegalovirus infection was excluded and no other pathogen was detected.

g, h Acute colitis with hemorrhagic erosions (g) and submucosal hemorrhages (h). No pathogen detected.

Acute colitis with massive mucosal edema, isolated hemorrhaging, and small, erosive defects in a 64-year-old patient who was treated with immunosuppressants following a kidney transplant. Cytomegalovirus infection was excluded and no other pathogen was detected.

Cytomegarovirus Colitis Pathology

Fig. 13.25 Diversion proctitis in a rectal stump in a patient who had undergone a Hartmann procedure. The patient presented with recurrent anal bleeding.

Fig. 13.24 Diversion colitis after attachment of an ileostomy due to peritoneal car cinosis in ovarian cancer.

Fig. 13.25 Diversion proctitis in a rectal stump in a patient who had undergone a Hartmann procedure. The patient presented with recurrent anal bleeding.

Fig. 13.26 Rectal ulcer in radiation proctitis. The 64-year-old female patient had undergone radiation therapy for uterine cancer.

HIV infection. The causes of lower gastrointestinal bleeding in patients with HIV differ from those in other patients. The most common are cytomegalovirus colitis (25%), lymphoma (12%), and idiopathic (unidentifiable) colitis (12%) (7). The first two causes are especially pronounced in patients with a CD4 lymphocyte count below 200/mm3. If cell count is greater than 200/ mm3 the most common bleeding sources are idiopathic colitis, diverticula, and hemorrhoids. Rebleeding is not uncommon. Thirty-day mortality related to bleeding is around 14 %, whereby patients with concomitant medical problems, rebleeding and those requiring operative intervention are especially at risk. In a study by Bini et al. (7), bleeding was controlled endoscopically in nearly all patients by means of bipolar thermocoagulation probes, with or without epinephrine injection. In a study by Chalasani et al. (12), the most common cause of bleeding was also cytomegalovirus infection, followed by hemorrhoids and anal fissures. Thrombocytopenia was a particular risk factor for hemorrhoid bleeding. Further bleeding sources in patients with HIV are histoplasmosis of the colon, Kaposi's sarcoma in the colon, and bacterial colitis.

Diversion colitis. Diversion colitis (Figs. 13.24,13.25) sometimes manifests clinically as blood loss. This type of colitis is caused by bacterial imbalance of the colon mucosa resulting from lacking fecal stream after the attachment of a stoma (Fig. 13.24) or a Hartmann procedure (Fig. 13.25). Diminished levels of short-chain fatty acids in the colonic lumen, which nourish the mucosa, are blamed etiopathogenically.

Radiation colitis. Radiation therapy can cause acute and subacute radiation colitis (Figs. 13.26-13.28) in the colon, particularly in the rectum and sigmoid colon, and occasionally heavy loss of blood. The cause of radiation colitis is disrupted cellular proliferation and regeneration as well as induction of inflammatory processes in the colonic mucosa. Possibilities for endo-scopic therapy are usually limited.

Nonsteroidal anti-inflammatory drugs (NSAID). Nonsteroidal anti-inflammatory drugs can promote bleeding from any number of possible lesions in the gastrointestinal tract.

Nonsteroidal anti-inflammatory drugs can also induce colitis, which may not be visibly discernible from infectious colitis or chronic inflammatory bowel disease (Figs. 13.29,13.30). However, its endoscopic aspect can also include flat and usually irregularly bordered erosions and ulcerations, which are surrounded by an otherwise normal appearing mucosa (s 13.5). Individual lesions may bleed.

Sigmoid Colon Resection
Fig. 13.27 Ulceration at rectosigmoid anastomosis with prior resection of a sigmoid carcinoma and chemoradiotherapy. Several visible vessels can be seen on the edge of the ulceration.

Fig. 13.28 Severe radiation-induced hemorrhagic inflammation of the mucosa at a rectosigmoid anastomosis following prior resection of an adenocarcinoma and chemoradiotherapy. Recurrent blood loss from massively inflamed mucosa in this region, which was difficult to treat endoscopi-cally.

Fig. 13.29 Pronounced colitis with reddened mucosa and fibrinous exudates, primarily affecting descending colon, related to use of nonsteroidal anti-inflammatory drugs.

Proctitis Nonsteroidal Anti Inflammatory
- 0 13.5 Ulcers in use of anti-inflammatory drugs
Sigmoid Colon

b c a Diffuse ulcers affecting the entire colon. b, c Ulcer with adherent clot near an ileocolic anastomosis in a 46-year-old patient using anti-inflammatory drugs (b). The visible vessel underneath the clot was hemoclipped (Olympus) (c).

CT C

t5 c

TO U

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook


Post a comment