A Case of Ulcerative Colitis with Macroscopic Rectal Sparing

Abstract

A 35-year-old female patient, admitted with frequent mucoid bowel movements and lower abdominal pain, was suspected of having ulcerative colitis. She did not receive any treatment for ulcerative colitis prior to her admission. Despite the typical findings of ulcerative colitis in the transverse and descending colons on double-contrast barium enema and colonoscopy, the rectum was grossly normal. Such colonoscopic findings seemed to exclude the diagnosis of ulcerative colitis. However, rectal biopsy showed typical histologic changes of ulcerative colitis. The purpose of this paper is to emphasize the importance of biopsy and histological assessment of the rectal mucosa in suspected cases of ulcerative colitis, even if the rectal mucosa is grossly normal on colono- or sigmoidoscopy.