Surgical Treatment of the Patient with Non- specific Colon Ulcer

Jeong, Seong Hun; Kim, Cheong Yong; Byun, Joo Nam

Abstract

PURPOSE
Non-specific ulceration of colon is a rare disease of unknown etiology. To establish correctly the diagnosis of nonspecific colon ulcer preoperatively is difficult, but with more wide spread use of colonoscopy and complementary diagnostic aids, this lesion may be accurately diagnosed more often. The presentating symptoms were mainly lower abdominal pain, which mimic such conditions as acute appendicitis, diverticulitis, intestinal obstruction, and colon cancer. If its serious complications (perforation, abscess formation, or uncontrolled bleeding) were developed, resection of ulcerated segment or more extensive colectomy was recommended. The purpose of this study was to establish correctly the diagnosis of nonspecific colon ulcer preoperatively and to identify definitive treatment of complicated colon ulcer.
METHODS
6 cases, surgically treated as non-specific colon ulcer at Chosun University hospital from January 1995 to December 1999 were studied retrospectively.
RESULTS
The ages of the patient ranged from 35 to 70 years; the ratio of male to female is 2: 1. The main clinical symptoms were abdominal pain (6 cases), nausea and vomiting (4 cases), hematochezia (3 cases), constipation (2 cases) and palpable mass (1 case). The preoperative diagnosis was generalized peritonitis (2 cases), colon cancer (2 cases), acute appendicitis (1 case), mechanical obstruction (1 case). 3 cases had past medication history, one was anti-hypertensive drug and the two were nonsteroidal anti-inflammatory drug. The preoperative diagnostic study were simple abdomen (6 cases), abdominal CT (6 cases), colon study (3 cases), abdominal sonograph (4 cases) and selective angiogram (1 cases), The location of ulcer were cecum (2 cases), sigmoid colon (2 cases), transversecolon (1 case) and descending colon (1 case). The methods of operation were hemicolectomy (3 cases), segmental resection (1 case) and anterior resection (2 case). There was one death, but 5 cases were completely recovered.
CONCLUSIONS
Non-specific ulcer of the colon is not detected until complicated by bleeding, perforation, or obstruction. The patient who has chronic abdominal pain and rectal bleeding can be diagnosed preoperatevely by colonoscopy and colon study. The recommended therapy of complicated cases is resection of the ulcerated segment or more extensive colectomy. Non-specific colonic ulcer should be suspected as one of colonic disease in the patients with complications.