eMedicine Specialties > Radiology > Gastrointestinal

Ulcerative Colitis: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Aali J Sheen, MD, MBChB, FRCS, Consulting Hepatobiliary Surgeon, HepatoBiliary Unit, Manchester Royal Infirmary; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Haren Varia, MB ChB, FRCR, Consultant, Department of Clinical Radiology, Blackpool, Fylde and Wyre NHS Trust
Contributor Information and Disclosures

Updated: Jan 30, 2009

Intervention

Chronic ulcerative colitis is associated with an increase in the risk of carcinoma. Surgery should be contemplated only when (1) 2 biopsy samples evaluated by 2 pathologists confirm the findings, and (2) low-grade dysplasia is present in a raised lesion. As yet, no evidence suggests that regular endoscopic screening of patients with ulcerative colitis improves survival.

The treatment of ulcerative colitis relies on initial medical management with corticosteroids and anti-inflammatory agents, such as sulfasalazine, in conjunction with symptomatic treatment with antidiarrheal agents and rehydration. Surgery is contemplated when medical treatment fails or when a surgical emergency (eg, perforation of the colon) occurs. Surgical options include total colectomy (panproctocolectomy) and ileostomy, total colectomy, and ileoanal pouch reconstruction or ileorectal anastomoses. In an emergency situation, subtotal colectomy with end-ileostomy is recommended.30,31,32

Medicolegal Pitfalls

  • A colonic carcinoma may easily be missed in the setting of ulcerative colitis.

Special Concerns

  • Barium enema examinations should be performed with caution in patients with suspected acute ulcerative colitis.
    • The examination is usually individualized. If the patient is relatively asymptomatic, a single-contrast enema may suffice. However, if the patient is hospitalized because of an acute exacerbation, it may be best to avoid a barium enema.
    • For patients with chronic ulcerative colitis, if bowel preparation is needed at all, only a mild laxative may suffice. With active disease, bowel perforation may occur, and bowel gas may extravasate into the portal venous system without an obvious perforation.
    • A careful double-contrast barium enema without bowel preparation may be performed in a chronic setting.
  • Massive colonic hemorrhage, toxic megacolon, and perforation are known complications of ulcerative colitis.
 


More on Ulcerative Colitis

Overview: Ulcerative Colitis
Imaging: Ulcerative Colitis
Follow-up: Ulcerative Colitis
Multimedia: Ulcerative Colitis
References
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References

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Further Reading

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Keywords

ulcerative colitis, UC, inflammatory bowel disease, IBD, ulcerative proctocolitis, crypt abscesses, fulminant colitis, toxic megacolon, Crohn disease, Crohn's disease, CD

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Aali J Sheen, MD, MBChB, FRCS, Consulting Hepatobiliary Surgeon, HepatoBiliary Unit, Manchester Royal Infirmary
Aali J Sheen, MD, MBChB, FRCS is a member of the following medical societies: British Medical Association, International Hepato-Pancreato-Biliary Association, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Haren Varia, MB ChB, FRCR, Consultant, Department of Clinical Radiology, Blackpool, Fylde and Wyre NHS Trust
Disclosure: Nothing to disclose.

Medical Editor

Jocelyn D Chertoff, MD, Associate Professor of Radiology and Obstetrics/Gynecology, Dartmouth Medical School; Consulting Staff, Department of Diagnostic Radiology, Dartmouth-Hitchcock Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

David Andrew Nicholson, BM, BS, FRCR, Honorary Lecturer, Department of Radiology, University of Manchester; Consultant Gastrointestinal Radiologist, Department of Radiology, Hope Hospital, Salford Royal Hospital NHS Trust
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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