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Complications Associated With Inflammatory Colitis.

AJR 2015; 205:W139 0361–803X/14/2051–W139 © American Roentgen Ray Society Complications Associated With Inflammatory Colitis We read with great interest the article titled “Colorectal Emergencies and Related Complications: A Comprehensive Imaging Review—Imaging of Colitis and Complications” by Maddu et al. [1] published in the December 2014 issue of the AJR. We wish to highlight a few important complications that may be associated with inflammatory colitis that should not be overlooked. Fulminant colitis is an important complication, particularly in patients with ulcerative colitis, that can present as ileus in an emergency setting. This complication affects less than 10% of people with colitis and is caused by transmural damage of the intestinal wall that results in an extremely dilated and swollen colon. The normal motility of the intestinal wall stops temporarily, and abdominal distention occurs. As the condition progresses, the colon loses muscle tone and begins to expand. On conventional abdominal radiographs, trapped gas is seen inside the paralyzed portions of intestine. This entity is termed “toxic colitis” when it is seen in patients with Crohn disease. In addition, bile salt diarrhea can present as an electrolyte imbalance in the emergency setting in patients with Crohn disease because the ileum is often involved. The ileum is the principal area for intestinal absorption of bile acids, which help in the transportation and absorption of fats; if these compounds become deficient, fat malabsorption and diarrhea can result [2]. Extraintestinal complications can present either separately or in combination with acute locoregional complications of the bowel in an emergency setting. These complications are acute cholecystitis, choledocholithiasis, sclerosing cholangitis, liver abscess, pancreatitis, hydronephrosis (from ureteric compression, generally on the right side), urinary tract stones, cystitis, sacroiliitis, spinal ligamentous ossification, osteomyelitis, septic arthritis, muscle abscesses, and avascular necrosis of the femoral heads. Patients with ulcerative colitis and patients with Crohn disease have a markedly increased risk of developing cancer of the gut. Adenocarcinoma and lymphoma of the small bowel and colon, particularly in the bypassed or excluded segments of the gastrointestinal tract, are more common in Crohn disease [3]. Localized giant pseudopolyposis, which can mimic malignancy or villous adenoma and can present with intestinal obstruction, may also be seen, particularly in patients with ulcerative colitis. It usually involves the transverse or the descending colon. Malignancy in ulcerative colitis is usually in the form of a constrictive stricture or ulceration, but a polypoidal lesion warrants further investigation to rule out malignancy [4]. Binit Sureka Kalpana Bansal Ankur Arora Department of Radiology, Institute of Liver & Biliary Sciences, New Delhi, India