Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 28, 2006; 12(36): 5913-5915
Published online Sep 28, 2006. doi: 10.3748/wjg.v12.i36.5913
Diffuse gastroduodenitis and pouchitis associated with ulcerative colitis
Hiroki Ikeuchi, Kazutoshi Hori, Takashi Nishigami, Hiroki Nakano, Motoi Uchino, Mitsuhiro Nakamura, Nobuaki Kaibe, Masafumi Noda, Hidenori Yanagi, Takehira Yamamura
Hiroki Ikeuchi, Hiroki Nakano, Motoi Uchino, Mitsuhiro Nakamura, Nobuaki Kaibe, Masafumi Noda, Hidenori Yanagi, Takehira Yamamura, Second Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
Kazutoshi Hori, Department of Gastroenterology, Hyogo College of Medicine. Hyogo, Japan
Takashi Nishigami, Second Department of Pathology, Hyogo College of Medicine. Hyogo, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Hiroki Ikeuchi, MD, 1-1 Mukogawa-cyo, Nishinomiya, Hyogo 663-8501, Japan. ikeuci2s@hyo-med.ac.jp
Telephone: +81-798-456372 Fax: +81-798-456373
Received: April 13, 2006
Revised: July 2, 2006
Accepted: July 7, 2006
Published online: September 28, 2006
Abstract

We experienced a very rare case of ulcerative colitis (UC) accompanied with analogous lesions in the stomach, duodenum, and ileal J -pouch. Ileal J-pouch anal anastomosis was performed on a 29-year old woman in 1996. Six years later, she was admitted again to our hospital because of epigastralgia, nausea, watery diarrhea and low fever. Based on the results of endoscopic examination, we diagnosed it as pouchitis. Moreover, on hypotonic duodenography, expansion of the duodenal bulb and the descending portion were poor. Kerckring folds disappeared with typical lead-pipe appearance. The pathogenesis of the gastric and duodenal lesion in this patient was similar to that of the colonic lesions of UC. For the gastroduodenal lesions in this patient, symptomatic remission was obtained following administration of crushed mesalazine tablets (1500 mg/d) for 14 d with continuous administration of omeprazole. Firstly we used ciprofloxacin to treat pouchitis. On the fifth day, she got a fever because of catheter infection. In the catheter culture, methicillin-resistant Staphylococcus aureus (MRSA) was detected. Therefore we changed ciprofloxacin to vancomycin hydrochloride (Vancomycin®). Vancomycin was very effective, and the stool frequency dramatically improved in three days. Now she continues to take mesalazine, but her condition is stable and there has been no recurrence of pouchitis.

Keywords: Ulcerative colitis; Pouchitis; Gastroduodenal lesions