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A 56-year-old man presented with a change in bowel habit to seven loose non-bloody stools a day. He had previously had a sigmoid resection for an endoscopic diagnosis of colonic malignancy in 2015. Histology of the resection specimen, however, had only shown inflammatory polyps, attributed to the accompanying diverticular disease.
His current colonoscopy showed two malignant looking lesions in the descending colon (figure 1) and the hepatic flexure (figure 2) with multiple additional sub-5 mm polyps in the ascending colon (figure 3). The intervening colonic mucosa was inflamed with appearances suggesting ulcerative colitis. A CT scan showed a 12 cm segment of thickening at the hepatic flexure. Mucosal biopsies showed chronic active inflammation in the intervening mucosa in keeping with ulcerative colitis but there was …
Contributors JA, TEC and SS were involved in the initial drafting of the manuscript. FC, PJS, FM and TA revised the manuscript. All authors were involved in final revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PJS has received speaker fee from Takeda and is an advisory board member for Celltrion. SS has received speaker fees from MSD, Actavis, Abbvie, Dr Falk pharmaceuticals, Shire and received educational grants from MSD, Abbvie, Actavis and is an advisory board member for Abbvie, Dr Falk pharmaceuticals and Vifor pharmaceuticals.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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