Severe and Extensive Enteritis following Colectomy for Ulcerative Colitis

Abstract

Ulcerative colitis is an inflammatory condition usually confined to the colonic mucosa. However, inflammatory changes have been recorded in the small bowel with ulcerative colitis, specifically in ileal pouch mucosa after colectomy (ie, ‘pouchitis’) or in the terminal ileum with severe pancolitis (ie, ‘backwash ileitis’). There have also been rare previous reports of a more diffuse and distinctive form of diffuse and extensive enteritis following total colectomy that responded to steroids or calcineurin inhibitor use (1–3). Rarely, a fatal form of diffuse enteritis following colectomy has been described (4,5). We report a dramatic presentation of severe steroid-resistant panenteritis in a patient three months after total colectomy for severe ulcerative colitis that responded to tacrolimus.