Crohn´s disease vs. Ulcerative Colitis
Right picture: The diagnosis is a pancolitis in ulcerative colitis. In more than 10 % of the patients the symptoms and signs of the disease begin between 10 and 20 years of age, and children are more likely to develop pancolitis as in the presented case. Some of them require surgery, if medical therapy fails. In toxic megacolon emergency colectomy should be performed as in the presented case. Left picture: The final diagnosis is a Crohn´s disease in which a non-operative treatment was possible for two years. Afterwards, surgery was needed due to a nearly total stenosis of the small intestine and sequels in the ileocecal region. Following an ileocecal resection, a terminal ileostomy was performed. Notice the stenosis in the operative preparation from the outside (third picture from the top) and at the divided intestine (fourth picture from the top). Right picture: In contrast to Crohn´s disease with slight diarrhoea which is only occasionally hemorrhagic (for instance in secondary anal fissures or fistulas), watery and hemorrhagic stools belong to the leading symptoms of ulcerative colitis.
Left picture: The history of this teenager tells us that the 14.4-year-old girl has been admitted to the emergency ward due to abdominal colics and vomiting persisting for more than 24 hours. Right lower abdominal pain and localized tenderness on percussion and on deep palpation were present, as well as a movable mass. On ultrasound a conglomerate tumor was visible in the right lower abdomen which led to further work-up examinations. A non-operative treatment was performed. Operative findings at laparotomy two years later: In the first picture from the top the dilated terminal ileum is visible on the left side. On the right side, adhesions in the ileocecal region are recognizable following multiple fistulas, and at the top, a stenosis of the small intestine. In the second picture from the top the part of the small intestine which is adjacent to the stenosis is stretched; the stenosis does not seem to be considerable. The line between the intestinal serosa and the fatty tissue is interrupted. The dilated lymphatic vessels also extend to the serosa of the involved intestinal segment. Right picture: 16.1-year-old girl with repeated episodes of cramping lower abdominal pain and of diarrhea with blood, mucus and pus for some time already. The teenager has always felt tired. Recently, fulminating relapse with profuse bloody diarrhea and development of a toxic megacolon which has not responded to medical therapy. The preparation after emergency surgery shows instead of a normal surface of the mucous membrane absence of folds, large pseudopolyps, and parts of atrophic mucosa of the whole colorectum in a circular manner.