Publication:
A challenge in diagnosis and management of ulcerative colitis in elderly patient with atypical presentation: A reported case

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Issued Date

2019

Resource Type

Article

File Type

application/pdf

ISSN

22102612

DOI

10.1016/j.ijscr.2019.07.008

Other identifier(s)

2-s2.0-85073649179

Rights Holder(s)

Scopus

Bibliographic Citation

International Journal of Surgery Case Reports. Vol 61, (2019), p.234-237

Suggested Citation

Kongon P., Tangsirapat V., Ohmpornuwat V., Sumtong K., Chakrapan Na Ayudhya V., Chakrapan Na Ayudhya K., Sookpotarom P., Vejchapipat P. A challenge in diagnosis and management of ulcerative colitis in elderly patient with atypical presentation: A reported case. International Journal of Surgery Case Reports. Vol 61, (2019), p.234-237. doi:10.1016/j.ijscr.2019.07.008 Retrieved from: https://hdl.handle.net/20.500.14740/5644

Title

A challenge in diagnosis and management of ulcerative colitis in elderly patient with atypical presentation: A reported case

Author(s)

Kongon P.
 Tangsirapat V.
 Ohmpornuwat V.
 Sumtong K.
 Chakrapan Na Ayudhya V.
 Chakrapan Na Ayudhya K.
 Sookpotarom P.
 Vejchapipat P.

Abstract

Introduction: Recognition of elderly-onset ulcerative colitis (UC) remains poor as the differential diagnosis in older patients with acute abdominal pain and bloody diarrhea is extensive and UC is generally not the obvious cause. A typical presentation in an elderly patient with acute severe UC can mimic surgical abdomen. Presentation of case: An 80-year-old female had been presented with high grade fever, abdominal pain and diarrhoea. Physical examination showed sign of peritonitis and severe hypotension. A provisional diagnosis of perforated sigmoid diverticulitis was made. However, at the theater, there was only turbid yellowish ascites at cal-de-sac. Consequently, colonoscopy was performed and revealed continuous and circumferential erythematous with friable mucosa and multiple shallow ulcer along upper left side colon. Histologic examination of the colonic tissue was consistent with UC. Discussion: As UC is uncommon in Thailand and clinical features of elderly-onset UC are much more non-specific; as a result, misdiagnosis at initial presentation is more common in elderly patients (60%) than that in younger population (15%). These might result in an unnecessary exploratory laparotomy; however, computed tomography scan can reduce the risk of that event. Conclusion: The diagnosis of severe acute UC in elderly patients with acute abdomen had been complicated by the distinctive physiology of this aged group with atypical presentation and markedly unreliable physical examination. Eventually, severe UC should always be kept in mind with a circumstance of abdominal pain in geriatric population. © 2019 The Authors

Subject(s)

Ciprofloxacin
 Creatinine
 Hypertensive factor
 Metronidazole
 Sodium chloride
 Abdominal pain
 Abdominal radiography
 Abdominal tenderness
 Aged
 Antibiotic therapy
 Article
 Ascites
 Blood pressure
 Body temperature
 Case report
 Clinical article
 Colon tissue
 Colonoscopy
 Computer assisted tomography
 Creatinine blood level
 Creatinine clearance
 Diarrhea
 Diverticulitis
 Fatigue
 Feces analysis
 Female
 Fever
 Follow up
 Glomerulus filtration rate
 Heart rate
 Histopathology
 Human
 Human tissue
 Hypotension
 Leukocyte count
 Loss of appetite
 Neutrophil count
 Peritonitis
 Physical examination
 Priority journal
 Ulcerative colitis
 Very elderly
 Weakness

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URI

https://hdl.handle.net/20.500.14740/5644

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Scopus: Year 1983-2021

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