Childhood Ulcerative Colitis: Rectal Cancer

Abstract

The patient, aged 9 years, was first seen by the author within a few days of the first episode of diarrhea and rectal bleeding (1972). Within 1 week, a significant proctocolitis to 20cm was apparent. Treatment with intermittent courses of prednisolone and maintenance with sulphasalazine was supervised by the attending gastroenterologist. In 1982, colonoscopy revealed total chronic colitis with pseudopolyp formation, and biopsies were consistent with ulcerative colitis. The patient’s family rejected proctocolectomy at this time. An exacerbation of the colitis resulted in a short hospital stay in 1988. Follow-up colonoscopies revealed slow progressions of the colitis with pseudo polyps, contraction and rigidity of the distal colon. No dysplasia was identified in random biopsies. Colonoscopy (9.23.94) identified chronic active disease in the right colon and more acute inflammation in the left colon and rectum. The patient was advised to undergo restorative proctocolectomy but declined. Thirteen months later, cystoscopy was performed to investigate dysuria and hematuria. Inflammatory changes were present in the bladder. Sigmoidoscopy now revealed an obstructing carcinoma in the upper third of the rectum (Figure 62.1).