Emergency colectomy for massive rectal bleeding in a patient with well-controlled ulcerative colitis receiving Vedolizumab

• Published in: Archive of clinical cases Vol. 10; no. 3; pp. 133 - 137
• Main Authors: Ciortescu, Irina, Nemteanu, Roxana, Gheorge, Liliana, Hincu, Corina, Fortu, Liliana, Chiriac, Oreste, Clim, Andreea, Plesa, Alina
• Format: Journal Article
• Language: English
• Published: Iași, Romania Archive of Clinical Cases 01-09-2023; UMF “Gr. T. Popa” Iasi Publishing House
• Subjects: Case Report; Colectomy; Development and progression; Gastrointestinal bleeding; Ulcerative colitis
• ISSN: 2360-6975; 2360-6975
• DOI: 10.22551/2023.40.1003.10259

Ulcerative colitis (UC) is a chronic inflammatory condition, with a relapsing-remitting course. The case presented poses some valid questions regarding short-term and long-term management of patients with UC, and if the outcome (colectomy) could have been delayed or even prevented. Rectal bleeding is a cardinal symptom in patients with UC and it occurs among all patients during active disease. Massive rectal bleeding is an uncommon, but serious, complication of UC accounting for 0.1-1.4% of admissions. It is, nonetheless, noteworthy that instances of acute significant lower gastrointestinal bleeding accompanied by hemodynamic instability are infrequent. The rate of colectomy appears to be positively impacted by biological treatment. However, a refractory condition is still the primary reason for surgery, indicating a pressing need for new treatment approaches. Here we present the case of a young male patient who developed massive rectal bleeding and underwent emergent colectomy with ileostomy while having clinical and biological remission (normal calprotectin levels) at week 10 of Vedolizumab treatment.