A Pediatric Case of Ulcerative Colitis Requiring Emergency Operation due to Arterial Hemorrhage from a Deep Ulcer

We report a pediatric case of ulcerative colitis (UC) requiring emergency operation because of massive hemorrhaging per arterial rhexis from an ulcer of the ascending colon. The patient, a 12-year-old boy, presented with abdominal pain and bloody bowel discharge in September 2003. He was diagnosed as having UC and treated medically by his family doctor with predonisolone (PSL) and 5-acetylsalicylic acid (5-ASA). While his symptoms were temporarily alleviated, his condition deteriorated in October of the same year and he was referred and admitted to the pediatric department of our hospital. His condition was stabilized temporarily by medical intervention but worsened in May 2004, with more bloody discharge. On June 2, excessive bloody discharge was noted, and the medical treatment he had been receiving was deemed ineffective. The next day, an emergency colonoscopic examination was performed and an arterial hemorrhage from a deep isolated ulcer (intrinsic muscle layer denudation) in the ascending colon was diagnosed. Since endoscopic hemostasis was difficult, the patient was referred to our department for emergency surgery. Arterial hemorrhaging from an ulcer is extremely rare in patients with UC and is beyond medical treatment. Therefore, in such situations, early diagnosis and surgery are required. Particularly in pediatric UC, the incidence of which is increasing, many severe and fulminant cases have been reported, and the eruption rate when the whole of the colon is affected is high. Consequently, surgery should be performed immediately when necessary for the treatment of pediatric UC.