Gastroduodenitis associated with ulcerative colitis:A case report

BACKGROUND Ulcerative colitis(UC)is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel.In addition,UC affects only the large bowel except for backwash ileitis and pouchitis,whereas Crohn’s disease(CD)affects the entire digestive tract.Inflammatory bowel disease(IBD)patients tend to be diagnosed with CD or indeterminate colitis when combined with gastric lesion.However,in recent years,some UC patients are reported to have various degrees of lesions in gastroduodenum.Here,we report a case of gastroduodenitis associated with UC(GDUC).CASE SUMMARY A 25-year-old man with a history of Klippel-Trenaunay syndrome presented to the hospital with mucopurulent bloody stool and epigastric persistent colic pain for 2 wk.Continuous superficial ulcers and spontaneous bleeding were observed under colonoscopy.Subsequent gastroscopy revealed mucosa with diffuse edema,ulcers,errhysis,and granular and friable changes in the stomach and duodenal bulb,which were similar to the appearance of the rectum.After ruling out other possibilities according to a series of examinations,a diagnosis of GDUC was considered.The patient hesitated about intravenous corticosteroids,so he received a standardized treatment with pentasa of 3.2 g/d.After 0.5 mo of treatment,the patient’s symptoms achieved complete remission.Follow-up endoscopy and imaging findings showed no evidence of recurrence for 26 mo.CONCLUSION The occurrence of gastrointestinal involvement in UC is rare,which may open a new window for studying the etiology and pathogenesis of UC.Physicians should consider broad differential diagnosis by endoscopic biopsy and laboratory examinations.

Intestinal obstruction in pregnancy with reverse rotation of the midgut:A case report

BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation.Volvulus of the right colon or entire midgut,stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation.In this study,we report the first case of intestinal obstruction associated with reverse rotation in pregnancy.CASE SUMMARY A 31-year-old woman at 362+wk gestation presented to the emergency department with progressive abdominal cramping,nausea and bilious vomiting.Abdominal ultrasound scanning showed dilatation of the bowel.Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus.After consultation with the obstetrician,the pregnancy was terminated and exploratory abdominal surgery was performed.Intra-operatively,it was found that the mesentery of the colon and small intestine was insufficiently attached.The right colon and the small intestinal mesentery was twisted,and intestinal necrosis was observed.The duodenum and duodenojejunal junction were curved in front of the transverse colon,and the transverse colon passed through the tunnel behind the mesenteric root.Intestinal reverse rotation with volvulus was confirmed.The necrotic intestine was resected and small intestine mesenteric reconstruction was performed.The patient recovered after surgery.After leaving the hospital,the patient and her daughter remained well during an 8-month follow-up period.CONCLUSION We report the diagnosis,treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut.For similar cases,appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.