Rectosigmoid disease

The first-line of treatment for mild to moderate ulcerative colitis or Crohn s colitis consists of oral sulfasalazine or mesalamine mesalamine or steroid enemas may be used for rectosigmoid disease. Delayed-release oral formulations of mesalamine may be used for Crohn s ileitis. 

Colitis in the rectosigmoid mucosa, with concomitant malabsorption, results in the characteristic sign of bacillary dysentery diarrhea tinged with blood and mucus. Shigellosis can be correctly diagnosed in most patients on the basis of fresh blood in the stool however, watery, mucoid diarrhea may be the only symptom of many Shigella infections. This disease differs from profuse watery diarrhea, as is commonly seen in choleraic diarrhea or in enterotoxigenic... 

Fig. 1.30a-e. Hirschsprung disease. Supine (a), upright (b) and lateral (c) plain radiographs show distension of the bowel corresponding to a low obstruction, with air-fluid levels in the upright film and absence of gas in the rectum in the lateral film. d,e Contrast enema shows a distended colon and an obvious zone of transition (arrows) in the rectosigmoid junction. The caliber of the rectum is very small... 

Fig. 1.31a,b. Hirschsprung disease. a Contrast enema shows a distended colon and a small rectum and portion of the colon. The rectosigmoid index is abnormal. b Intraoperative photograph demonstrates the transition zone (arrows) with the shape of an inverted cone... 

Abdominal radiography showed multiple diffuse calcium-like deposits throughout the digestive tract, especially in the rectosigmoid region. Sigmoidoscopy showed diverticular disease, with mucous membrane inflammation and off-white foreign bodies on the bowel wall, which were found to be lanthanum carbonate tablet residues. Her confusion resolved after withdrawal of lanthanum, and plasma lanthanum concentrations fell at the same time from 2.13 pg/1 on the day after withdrawal to 1.05 pg/1 on day 4 and 0.25 pg/l on day 7. 

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