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Q. Why did my 20-year-old son with ulcerative colitis feel better after passing a 10-inch-long thing?

Answered by
Dr. Varun Chaudhry
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 28, 2022

Hello.,

My 20-year-old son was diagnosed with ulcerative colitis about five months ago. Some doctors thought it was infectious. He has had months of horrid pain (like eating glass shards) and bleeding so much that he became anemic. He did not respond to any medicines, including Mesalamine (in fact, this medicine started the awful pain, prior to that, he had no pain, he had only bleeding). His only positive response was after antibiotics. He was given the antibiotics (short course) while he was hospitalized three months back but did not take them afterward. Within a week or two, he began to have the symptoms of pain and bleeding again.

Two weeks ago, while in nearly unbearable pain, with a weight loss of over 30 pounds (he is 5' 11" and now weighs 160 pounds) and feeling hopeless, a doctor finally helped us. After a CT scan, he was immediately hospitalized again. He was placed on Vancomycin. Nothing else was prescribed at first. On day three, after about 11 doses of oral Vancomycin- his "glass shard" pain simply stopped. He had been feeling this intense pain (like glass shards coming down his intestines) for several months. It just stopped. A little while later (maybe an hour or so), they started Solu-Medrol - IV. A few days later, he was discharged. His WBC went up as high as 19.7k. His ANCA was as low as 6. His blood sugar (he is not diabetic) went as high as 157, and sodium dropped to 135.

He came back to the hospital a couple of days later, only to be admitted again. His rectal bleeding had increased, but the pain did not come back. They continued the Vancomycin (as he did at home) and the IV Solu-Medrol. No other medications were given. On day two of this admission, he became very lethargic, had hot or cold flashes, and would break out in a sweat. He slept all day and felt horrible. The following morning, after being on the toilet 12 times overnight - this 10-inch-long thing came out of him. Within a couple of hours, he was hungry and ate a full meal consisting of mac and cheese and chicken strips. For the first time in months, he did not run to the bathroom. He has been fine ever since - it has been seven days now, and he has no issues with eating. The bleeding stopped within 36 hours of passing whatever this thing was. They did start him on Humira and Emeran later that day after he ate two meals with no issues. Unfortunately, the nurse flushed the thing.

I wrote in for a consult already and had a picture of this thing that came out of him. It was 10 inches in length, so it stayed completely intact as he pulled it out. I realize you cannot tell from the picture but I hope you can see something on his CT scan. I have included a couple of pictures from that. Hopefully, you can let me know if you need other pics. Can you help us find an answer to what happened? Thank you.

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Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Thanks for your query, and I feel sorry to hear that your son had to go through such an ordeal.

From the limited coronal images you have provided (attachments removed to protect the patient's identity), I can see that the large bowel loops (sigmoid colon) are featureless, which is likely to represent ulcerative colitis.

Although I do not have all the images to evaluate fully, looking at the history, I think ulcerative colitis would be the most likely diagnosis since it waxes and wanes, which could be the reason for repeated bouts of pain.

Physicians sometimes need to give antibiotics for excessive inflammation or superadded infection. In addition, blood sugars can sometimes go up if steroids are given as a part of medication.

Do let me know if you have further queries.

Thanks.

Thank you, doctor,

The odd thing is his symptoms disappeared before the starting Humira and Emuran. Also, his Prometheus IBD panel came back with “not consistent with IBD.” It did not say inconclusive, but it said not consistent.

His symptoms have not waxed and waned. He had a normal CT scan about six months back. Then it was completely opposite barely three weeks later, with diffuse bowel wall thickening. He has progressively gotten worse only to improve for a very short term with antibiotics until now. He had no ups and downs. His condition just went progressively worse.

#

Hi,

Welcome back to icliniq.com

I understand your concern.

Thanks for clearing up the history part.

In that case, I think we have got two differentials for the complaint, and infection would be another possibility.

Since I have no previous images for comparison, I suggest it would be better to discuss with a physician. The pain might be due to infection-related colitis.

It is very difficult to differentiate the two based on imaging alone, so I would suggest discussing with the medical specialist treating you.

Thanks.


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