25612              ULCERATIVE COLITIS

The patient was a boy aged 15.  Episodes of pain and diarrhoea began at the age of 6 years.  Gradually the frequency and severity of the episodes increased.  At the age of 14 years, rectal bleeding began and continued with every bowel action.  Finally there was continuous diarrhoea up to eight times a day, with anorexia, loss of 6 kg in weight, and colicky abdominal pain.  The BP was 120/55.  There was no finger clubbing and the liver and spleen were not palpable.  Sigmoidoscopy showed florid acute proctitis and colitis.  Symptoms improved under treatment by salazopyrine together with prednisolone enemas.  He lived at home with his parents; his father was an alcoholic.  A year later symptoms still continued and he was still losing weight.  Further attacks occurred; one particular severe attack came soon after his father was released from jail.  Finally colectomy was performed.  Some days later a partial small bowel obstruction occurred, but thereafter the ileostomy functioned well.

The specimen consists of 21 cms of colon.  The bowel is thickened and cylindrical.  The muscle coat is thickened.  The mucosa is velvety and swollen, obliterating the transverse folds in many places.  Histology shows a few small shallow ulcers are present in the mucosa.  The villi are flattened and the surface is covered by simple columnar epithelium containing only occasional goblet cells.  Very few glands survive.  There is dense lymphoid infiltration beneath the mucosa, including many active germ centres.  The submucosa is thickened and somewhat oedematous and fibrous, but shows very little inflammation.  The muscle coats appear essentially normal.  Adjacent lymph nodes show sinus reaction in which eosinophils are conspicuous.