Gastroenterol. latinoam 2013; Vol 24, Nº2: 67-71
Corticorefractary ulcerative colitis in a puerperal woman. Clinical report
Autor(es):
✉ Pilar Manterola L., Rodrigo Irarrázaval del C., Claudia Mardones E., Carolina Heredia P. y Raúl Araya J.
For patients with bloody diarrhea, one of the possible diagnoses is ulcerative colitis. The case under analysis corresponds to a puerperal 19 year old woman, without any known medical record, presenting a fulminant pancolitis 40 days after delivery. The patient was admitted in the emergency room of “Hospital Militar” of Santiago, as a consequence of an important bloody diarrhea. She had hypotension, tachycardia and anemia, without fever so she was admitted into the Critical Care Unit. Abdominal CT showed that the colon was entirely dilated. Furthermore, the complete colonoscopy revealed pancolitis and pseudopolyps. There was no clinic improvement with the use of antibiotics, systemic steroids, oral 5-ASA, 5-ASA enemas and steroid enemas. The patient remained with bloody diarrhea; hence, infliximab treatment was started. She presented a satisfactory evolution, reducing the number of bowel movements and bleeding episodes. The biopsy confirmed ulcerative colitis. Treatment options for severe colitis that do not respond to steroids after 72 hours are: ciclosporin, anti-tumor necrosis factor therapy (infliximab) and surgery (colectomy). Anti-TNF, specifically infliximab, has shown response in 70% of fulminant colitis. For this purposes, the use of infliximab resulted in positive evolution with resolution of symptoms.
