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LETTER TO EDITOR
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 223-224

Proctosigmoiditis characteristic ultrasonography and color doppler findings


Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission28-May-2020
Date of Decision02-Dec-2020
Date of Acceptance15-Jan-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Suresh Vasant Phatak
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-4534.322609

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How to cite this article:
Patwa PA, Phatak SV, Madurwar K, Singh V. Proctosigmoiditis characteristic ultrasonography and color doppler findings. J Datta Meghe Inst Med Sci Univ 2021;16:223-4

How to cite this URL:
Patwa PA, Phatak SV, Madurwar K, Singh V. Proctosigmoiditis characteristic ultrasonography and color doppler findings. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 16];16:223-4. Available from: http://www.journaldmims.com/text.asp?2021/16/1/223/322609



Dear Editor,

We present a peculiar ultrasound finding of proctosigmoiditis in a case of inflammatory bowel disease – ulcerative colitis.

A 35-year-old Male patient came to the hospital with diarrhea and blood in stool for the past 20 days. He had decreased appetite, pain in the abdomen, and weight loss. On investigation, he had moderate anemia with hemoglobin, raised erythrocyte sedimentation rate, and raised C-reactive protein of 7.2 mg/dL, 78, and 8.4, respectively. A sigmoidoscopic examination revealed that the mucosa up to 25 cm from the rectum showed complete loss of vascular pattern, marked erythema, and ulcerations with areas of spontaneous bleeding suggestive of ulcerative colitis. The patient was sent for ultrasound abdomen and pelvis which revealed thickened bowel in the rectosigmoid region with high vascularity on Doppler and maintenance of its stratification and fluid around it. A diagnosis of proctosigmoiditis secondary to ulcerative colitis was made.

Ulcerative colitis is an inflammatory bowel disease characterized by mucosal inflammation of the colon, which is diffuse and affects the rectum extending proximally along variable lengths. The etiology of this inflammation is that although unclear, it seems to have its occurrence in genetically susceptible population in response to environmental triggers. Ulcerative colitis is thought to be an autoimmune disease due to the inflammatory response to colonic bacteria.[1] Ulcerative colitis, excluding the severe types, affects merely the mucosa and submucosa of the colon as an inflammatory ulcer. The mucosa in this scenario is edematous, causing its circulation to increase these correlates with increased bowel wall thickness. The engorged and dilated capillaries of the affected areas probably explain the increased circulation. A transabdominal ultrasound is helpful in the detection of bowel wall thickening and to examine the extent of involved segments of inflammatory bowel diseases.[2]

It is important to note that the typical sonographic appearance of normal bowel wall consists of five concentric, alternately echogenic, and hypoechoic layers from the lumen outward. Bowel wall thickening is a noteworthy sonographic correlate of bowel disorders, which may seem at first glance a very nonspecific sign, but the most widely used diagnostic criterion for the diagnosis of inflammatory bowel disease is thickened bowel wall with increased vascularity with maintenance of wall stratification. The bowel is said to be thickened when the wall is more than 3 mm in diameter.[3],[4]

To conclude, ultrasound has high sensitivity and specificity in the diagnosis of inflammatory bowel disease [Figure 1] and [Figure 2].
Figure 1: Color Doppler image showing hypervascularity of the bowel wall signifying inflammation

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Figure 2: Ultrasonography image showing thickened rectum and sigmoid colon (6 mm) with maintained stratification

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Collins P, Rhodes J. Ulcerative colitis: Diagnosis and management. BMJ 2006;333:340-3.  Back to cited text no. 1
    
2.
Bavil AS, Somi MH, Nemati M, Nadergoli BS, Ghabili K, Mirnour R, et al. Ultrasonographic evaluation of bowel wall thickness and intramural blood flow in ulcerative colitis. ISRN Gastroenterol 2012;2012:370495.  Back to cited text no. 2
    
3.
Ledermann HP, Börner N, Strunk H, Bongartz G, Zollikofer C, Stuckmann G. Bowel wall thickening on transabdominal sonography. AJR Am J Roentgenol 2000;174:107-17.  Back to cited text no. 3
    
4.
Strobel D, Goertz RS, Bernatik T. Diagnostics in inflammatory bowel disease: Ultrasound. World J Gastroenterol 2011;17:3192-7.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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