February 1978

Inflammatory Bowel Disease (Ulcerative Colitis)

Author Affiliations

From the Department of Medicine, Jewish Hospital of St Louis, and Washington University School of Medicine, St Louis.

Arch Intern Med. 1978;138(2):286-291. doi:10.1001/archinte.1978.03630260076020

Henry Mattis, MD, Junior Assistant Resident, Department of Medicine, The Jewish Hospital of St Louis: A 37-year-old married man, a high school teacher, had a 17-year history of ulcerative colitis that was initially diagnosed by protoscopy and barium enema. His symptoms have been characterized by frequent episodes of diarrhea with a minimal amount of bloody diarrhea. Although there is no history of adrenocorticoid steroid therapy, he had been subjected to prolonged, intermittent therapy with azulfidine at a dose of 3 gm day. He was initially admitted to Jewish Hospital because of a 9-kg weight loss and a palpable epigastric mass. A barium enema examination revealed severe chronic ulcerative colitis and a malignant right colonic lesion, and a liver scan was consistent with metastatic disease. A carcinoembryoantigen (CEA) value of 440 ng/ml was obtained (normal, < 2.5). During exploratory laparotomy, a lesion was identified at the hepatic flexure that had metastasized

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