TOTAL COLECTOMY FOR RELAPSING ULCERATIVE COLITIS: A CASE REPORT

Abstract

Ulcerative colitis, UC, and Crohn's disease (CD) are the main forms of inflammatory bowel disease (IBD). Morphologically, UC differs from CD by the continuity and uniformity of the inflammation that affects the diseased mucosa, with no interspersed parts of healthy tissue, resulting from ulcerated lesions and superficial erosions, in addition to mainly affecting the final portions of the large intestine. Furthermore, this is considered a progressive disease due to the high probability of intestinal dysmotility, anorectal dysfunction, the possibility of colectomy, and colorectal cancer. The treatment of UC is based on step-up or top-down therapy, with the use of corticosteroid induction and maintenance of immunobiological. However, patients refractory to treatment still require surgery, either due to therapeutic failure or neoplastic development. A male patient, 36 years old, with a history of UC since 2010, was initially treated as CD with aminosalicylates, but with loss of response to treatment after months of therapy. Therefore, immunosuppressants were introduced, which triggered two drug-induced pancreatitis. Subsequently, the use of corticosteroids and immunobiologicals was started, with improvement of symptoms, but with loss of response to chronic treatment and development of corticosteroid dependence. During the years of follow-up with the proctologist, all annual colonoscopies presented diagnostic impressions of UC in mild to moderate activity, without remission. In 2021, the lesions were staged according to the Mayo clinical classification (score 2), the Montreal classification (E3 and S2), and the Truelove-Witts severity index (severe). Furthermore, the patient began to present extraintestinal manifestations such as dermatological lesions, further affecting his quality of life. After 13 years of progressive symptom progression and without a good response to the proposed treatments, a total proctocolectomy with an ileal pouch was performed, resulting in an improvement in the patient's quality of life. It is concluded that UC is an inflammatory bowel disease with several spectrums and that severe cases negatively affect the quality of life of patients. The patient in question has a severe case that is refractory to the use of initial therapies, with periods of relapse even after optimization of the therapy. Therefore, surgical intervention of total proctocolectomy with ileal pouch was necessary, which directly impacted the patient's quality of life. Thus, it is noted that further studies are necessary to develop medications capable of acting in severe cases and in those refractory to traditional treatments, in addition to new analyses regarding the use of early surgical intervention.