Ulcerative Colitis is an inflammatory bowel disease that primarily affects the colon. Ulcerative colitis is often seen in young to middle aged patients. We can sometimes see findings that are indicate an inflamed colon on a CT scan
What is ulcerative colitis?
It is an inflammatory disease that primarily involves the colon and rectum.
What other parts of the body does ulcerative colitis involve?
The eyes, liver, joints and skin.
What causes ulcerative colitis ?
The cause is unknown but experts believe that genetics, environmental factors and immune dysfunction play a role.
Symptoms of ulcerative colitis
Ulcerative colitis presents with diarrhea, abdominal pain, rectal bleeding, anemia and fever.
What diagnostic test confirms ulcerative colitis?
Clinical history, laboratory testing and follow up with endoscopy with biopsy will allow a diagnosis to be made.
Ulcerative colitis on CT scan
The finding of a thickened or inflamed bowel will indicate colitis. Clues to the diagnosis of ulcerative colitis will be involvement of the rectum, continuous involvement of the colon without skip areas, and lack of involvement of the small intestine.
There are however many causes of thickened or inflamed bowel. This can be as a result of infection, Crohn’s disease, ischemic colitis, and even cancer.
Does ulcerative colitis always show up on CT scan?
No, not all cases of ulcerative colitis and inflammation show up on CT. Mild and early cases will often not be seen. Endoscopy with biopsy will detect ulcerative colitis.
What can be mistaken for ulcerative colitis?
Many types of colonic inflammation or colitis will have a similar appearance. Often the history and testing will help us come to a diagnosis. Some of the causes of colitis that can mimic ulcerative colitis can include: Crohn’s disease, infectious colitis, pseudomembranous colitis, radiation colitis, and chemical colitis.
Is ulcerative colitis dangerous? (or cancerous)
Patients with ulcerative colitis have an increased risk of colon cancer. Patients can also develop areas of colonic narrowing (strictures), bleeding from the colon and toxic megacolon which can lead to perforation of the colon.
CT scan for complications
CT scan will identify involved segments and the extent of disease.
Strictures or narrowing of the bowel can be identified. These can cause blockages.
An abnormal communication can occur between the bowel and another site called a fistula. This can occur to another segment of bowel or another organ such as the bladder.
Inflammatory bowel disease can also lead to perforation of the bowel. This can be a life threatening complication which needs prompt treatment. A perforation will allow air to escape into your abdomen and cause something we call free air.
An absess is another complication and is basically a walled off pocket of pus. This needs prompt treatment and drainage.
Ulcerative colitis treatment
Treatment can consist of anti inflammatory medications, immunosuppressants, biologics, iron supplements and anti diarrheal medications. Treatment is often managed by a gastroenterologist.
Resection of the colon and rectum provides a cure. The surgeon can create a pouch from the end of your intestine and connect it to the anus. This will preserve normal defecation.
Another option for those who can not have the j pouch procedure is to have an opening on the abdominal wall for the intestine. Stool is then collected in a bag.
Ulcerative colitis on CT scan: summary
Ulcerative colitis is an inflammatory condition of the colon and rectum of unknown cause. CT imaging can often identify an inflamed colon but can not provide a specific diagnosis of ulcerative colitis. Endoscopy with biopsy will be needed for diagnosis.