Product information "Ulcerative Colitis"
Clinical History
A 36-year-old woman was admitted with a 3-week history of bloody diarrhoea and lower abdominal pain. She reported four similar episodes over seven years. Sigmoidoscopy revealed erythematous, ulcerated, and oedematous rectal mucosa. Steroid treatment was started but symptoms persisted, leading to a total colectomy.
Pathology
The resected colon showed extensive confluent ulceration with oedematous mucosal islands. Ulcers had necrotic bases and overhanging edges forming pseudo-polyps. Histology revealed acute inflammation, crypt abscesses, necrosis, and ulceration, confirming acute ulcerative colitis (UC).
Further Information
Ulcerative colitis is a chronic ulcerative inflammatory disease mainly affecting the rectum and extending proximally in a continuous manner. Inflammation is usually limited to the mucosa and superficial submucosa. The cause is unknown. It commonly starts between ages 15–25 and is slightly more common in females. Symptoms include bloody or mucous diarrhoea, urgency, abdominal pain, weight loss, anemia, and fatigue. Complications include toxic megacolon, perforation, and colon cancer. Extraintestinal symptoms may affect eyes, joints, skin, and liver. Treatment includes steroids, disease-modifying drugs, and TNF inhibitors. Colectomy cures intestinal symptoms, but extraintestinal manifestations may continue.
A 36-year-old woman was admitted with a 3-week history of bloody diarrhoea and lower abdominal pain. She reported four similar episodes over seven years. Sigmoidoscopy revealed erythematous, ulcerated, and oedematous rectal mucosa. Steroid treatment was started but symptoms persisted, leading to a total colectomy.
Pathology
The resected colon showed extensive confluent ulceration with oedematous mucosal islands. Ulcers had necrotic bases and overhanging edges forming pseudo-polyps. Histology revealed acute inflammation, crypt abscesses, necrosis, and ulceration, confirming acute ulcerative colitis (UC).
Further Information
Ulcerative colitis is a chronic ulcerative inflammatory disease mainly affecting the rectum and extending proximally in a continuous manner. Inflammation is usually limited to the mucosa and superficial submucosa. The cause is unknown. It commonly starts between ages 15–25 and is slightly more common in females. Symptoms include bloody or mucous diarrhoea, urgency, abdominal pain, weight loss, anemia, and fatigue. Complications include toxic megacolon, perforation, and colon cancer. Extraintestinal symptoms may affect eyes, joints, skin, and liver. Treatment includes steroids, disease-modifying drugs, and TNF inhibitors. Colectomy cures intestinal symptoms, but extraintestinal manifestations may continue.
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Erler-Zimmer
Erler-Zimmer GmbH & Co.KG
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77886 Lauf
Germany
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Hirschsprung's Disease
Clinical HistoryA 5-year-old boy had a history of constipation since birth. A barium enema revealed a narrow rectum and a dilated sigmoid colon. Surgical resection of the affected bowel segment was attempted, but the patient died during the procedure.PathologyThe specimen shows a massively dilated sigmoid colon with loss of normal mucosal pattern. The adjacent rectum appears normal in size and structure but lacks ganglion cells in the myenteric plexus. This is consistent with Hirschsprung’s disease (congenital aganglionic megacolon).Further InformationHirschsprung’s disease results from the absence of parasympathetic ganglia in a segment of the bowel, most commonly the rectum. This leads to impaired peristalsis and functional obstruction. It is caused by a failure of neural crest cells to migrate during embryogenesis. The proximal colon becomes hypertrophied and dilated, increasing the risk of complications like enterocolitis and perforation.The disease occurs in approximately 1 in 5000 live births, more often in males and those with genetic syndromes such as Down syndrome. Mutations in the RET gene are implicated in many familial and some sporadic cases.Symptoms range from failure to pass meconium in newborns to chronic constipation and abdominal distension in older children. The standard treatment is surgical resection of the aganglionic bowel and connection of the healthy bowel to the rectum.
Liver cirrhosis
Clinical HistoryA 63-year-old man was admitted multiple times for bleeding from oesophageal varices. On admission, he was mildly febrile, jaundiced, and showed a severe flapping tremor of his hands. Other findings included ascites, prominent periumbilical veins, and haemorrhoids. He suffered a massive haematemesis and died shortly after.PathologyA liver slice revealed multiple well-demarcated nodules ranging from 1 to 7 mm in diameter. The liver surface was nodular and irregular. This represents cirrhosis of the liver with mixed micro- and macronodular patterns and significant fatty change.Further InformationThe most common cause of cirrhosis and fatty liver change is chronic alcoholism.
Cholelithiasis (Gallstones)
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Chronic Gastric Ulcer
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Multiple Polyposis Coli
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Gall Stone Ileus
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Fatty Liver
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Villous adenoma of colon
Clinical HistoryA 70-year-old man was admitted for muscular weakness and passing large amounts of mucus per rectum. He was found to be hypokalaemic. During investigations, a tumour in the sigmoid colon was discovered and later surgically removed.PathologyA 15 cm segment of colon was opened to reveal a large sessile tumour with a velvety surface, measuring 11 x 7 cm, located close to the distal resection margin. The mucosa elsewhere appeared normal, and the serosal surface was unremarkable. Histology confirmed a villous adenoma.Further InformationVillous adenomas can secrete large amounts of mucus and potassium-rich fluid, sometimes causing hypoalbuminaemia or hypokalaemia. They are the least common but most serious type of adenomatous polyps, with invasive carcinoma present in up to 30% of cases at resection.
Intussusception of small bowel due to metastatic tumour
Clinical HistoryA 66-year-old woman presented with sudden, severe, colicky central abdominal pain, which was somewhat relieved by drawing up her knees. She passed a stool described as containing mucus and blood ("like redcurrant jelly"). On examination, a mass in the left hypochondrium was noted, which hardened during spasms. A laparotomy was performed and the specimen resected.PathologyThe specimen is a 20?cm segment of small bowel with mesentery. A 3?cm polypoid tumour near the proximal margin has invaginated into the bowel lumen, forming a 13?cm long intussusception. The tumour lies at the apex of the invagination. The congested and exudative mucosa suggests early ischaemic necrosis. Although histology is not recorded, the macroscopic features are consistent with a metastatic malignant tumour.Further InformationIntussusception is most common in children, often due to enlarged Peyer’s patches in the distal ileum. In adults, it is rare (1–5?% of bowel obstructions) and typically caused by a polypoid tumour acting as a lead point, dragged forward by peristalsis. Symptoms include intermittent obstruction or severe pain. Abdominal CT often shows the characteristic “target sign”.
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