A 20-YEAR-OLD MAN WITH A RECENT DIAGNOSIS OF ULCERATIVE COLITIS had increasingly frequent bloody diarrhea and weight loss. He was admitted to our hospital after showing no response to treatment with intravenous corticosteroids, total parenteral nutrition, and a transfusion of packed red cells at another institution. A computed tomographic scan of the abdomen (Panel A) showed a severely dilated transverse colon (arrow) and free air (arrowhead). The patient underwent an emergency laparoscopic total abdominal colectomy with end ileos-tomy. The surgical specimen showed parallel lines of ulceration surrounded by inflamed mucosa (Panel B). Microscopically, the presence of crypt abscesses, lympho-plasmacytic infiltrates, and crypt architectural changes and the absence of granulomas were notable. The deep ulcerations extended into the muscularis propria (Panel C, hematoxylin and eosin). These gross anatomical and microscopical findings are common in fulminant ulcerative colitis. After surgery, the patient's condition improved and he was discharged home on postoperative day 8.
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