title: Diffuse gastroduodenitis and pouchitis associated with ulcerative colitis.
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.
authors.affiliation: Second Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan. ikeuci2s@hyo-med.ac.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hori
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishigami
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nakano
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nakamura
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kaibe
authors.forename: Masafumi
authors.initials: M
authors.lastname: Noda
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yanagi
authors.forename: Takehira
authors.initials: T
authors.lastname: Yamamura
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D004382:Duodenitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D005260:Female; D005756:Gastritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D019804:Mesalamine / Q000627:therapeutic use; D019449:Pouchitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine