Ulcerative Colitis Clinical Case Review

Cindy Law, MD, a gastroenterologist at Massachusetts General Hospital, discusses the baseline characteristics of the case:

Editor’s note: The following is an automatically generated transcript of the above video.

“Several months later, the patient returned to clinic and revealed that she was seven weeks pregnant. The recommended colonoscopy had not been performed. She reported increased symptoms including eight liquid stools per day with blood and abdominal pain, which raised concern for UC flare. We ordered blood work including CBC, CMP, CRP, as well as a stool infectious workup and a fecal calprotectin. Stool C. diff, and CNS returned negative the next day, however, the calprotectin results were still pending and would not be available for at least several days.

We discussed several options with the patient, including starting prednisone and performing a flexible sigmoidoscopy, however, we opted to utilize intestinal ultrasound since it was available in our clinic. Here are ultrasound images of the patient's sigmoid colon, for those unfamiliar with intestinal ultrasound, signs of inflammation include increased bowel wall thickness and hyperemia. You can see the thickened sigmoid colon here with red and blue doppler signals indicating hyperemia, these findings are consistent with active inflammation. We also scanned other sections of her bowel, the descending colon and transverse colon also showed bowel wall thickening and hyperemia. The ascending colon appeared normal.

Overall, this ultrasound demonstrated severe pancolitis, the fecal calprotectin, which became available later, was elevated above 2,000. We discussed these findings with the patient and she agreed to escalate therapy.”