Inflammatory Bowel Disease (Ulcerative Colitis)

Henry Mattis, MD, Junior Assistant Resident, Department of Medicine, The Jewish Hospital of St Louis: A 37-year-old married man, a high school teacher, had a 17-year history of ulcerative colitis that was initially diagnosed by protoscopy and barium enema. His symptoms have been characterized by frequent episodes of diarrhea with a minimal amount of bloody diarrhea. Although there is no history of adrenocorticoid steroid therapy, he had been subjected to prolonged, intermittent therapy with azulfidine at a dose of 3 gm day. He was initially admitted to Jewish Hospital because of a 9-kg weight loss and a palpable epigastric mass. A barium enema examination revealed severe chronic ulcerative colitis and a malignant right colonic lesion, and a liver scan was consistent with metastatic disease. A carcinoembryoantigen (CEA) value of 440 ng/ml was obtained (normal, < 2.5). During exploratory laparotomy, a lesion was identified at the hepatic flexure that had metastasized