Diseases of the Colon and Rectum

Treatment/Clostridium difficile Infection and Pseudomembranous Colitis

A 68-year-old woman complained of a 2-week history of loose stool and abdominal cramps. One month ago she was treated by her primary care physician for a sinus infection with amoxicillin.

Therapeutics/Colonic Polyps and Colon Cancer

A 42-year-old man presents to his primary care physician with a chief complaint of rectal bleeding. He is generally healthy and takes no medications.

Therapeutics/Abdominal Abscesses and Gastrointestinal Fistula

A 60-year-old male presents with a 2-day history of crampy left lower abdominal pain. The day of presentation he has a fever to 102°F. He has no change in his bowel habits and currently has two to three bowel movements per day.

Treatment/Acute Diverticulitis

A 70-year-old woman presented to the emergency room with a 3-day history of left lower quadrant pain, bloating, diarrhea, and nausea. Physical examination revealed a temperature of 38.0°C and laboratory evaluation showed leukocytosis. Computed tomography scan demonstrated diverticulosis of the sigmoid colon with associated bowel wall thickening and fat stranding but no pericolic fluid.

Therapeutics/Microscopic Colitis

A 68-year-old woman has a 10-month history of non-bloody diarrhea with abdominal pain. She occasionally passes mucus per rectum but does not have steatorrhea.

Therapeutics/Consequences of Human Immunodeficiency Virus Infection

A 26-year-old gay male was diagnosed with Human Immunodeficiency Virus infection 5 years ago. His CD4 nadir was 140cells/mm3 2 years after diagnosis, but he has been on antiretroviral therapy for 3 years with excellent adherence (last CD4 = 480cells/mm3 and Human Immunodeficiency Virus RNA undetectable).

Management/Acute Appendicitis

A 27-year-old male presents to the emergency department complaining of abdominal pain for the past 13 h. He describes the pain as gradual in onset and initially centered around the umbilicus that progressively intensified to become constant, severe, and predominantly right-sided.

Therapeutics/Acute Colonic Pseudo-obstruction

A 63-year-old man developed increasing abdominal distension 3 days after radical prostatectomy with bilateral lymph node dissection for prostate cancer. His postoperative course was complicated by atrial fibrillation with rapid ventricular response requiring intravenous rate control with calcium-channel antagonist medication in the ICU.

Therapeutics/Ulcerative Colitis

A 20-year-old male with no past medical history presents with 2 months of rectal bleeding, increasingly loose stools associated with urgency, and nocturnal bowel movements. Additionally, he describes intermittent, subjective, low-grade fevers, a 4.5 kg (10 pound) weight loss and bilateral pain and swelling in his knees.