Quite new

A 42-year old woman complains of the intermittent passage of bright red blood per rectum for the last two weeks. There is no associated abdominal pain, nausea, or vomiting.

She underwent a subtotal colectomy with an ileostomy six months ago, due to fulminant attacks of ulcerative colitis that were refractory to medical treatment.

She also tested positive for human immunodeficiency virus (HIV) six years ago and has been on regular anti-retroviral therapy ever since. Her last CD4 count, performed two weeks ago, was within normal limits.

The remainder of the history is unremarkable. A complete blood count (CBC) shows no abnormalities.

Select Relevant Investigations
Rectal cultures

Performed

Normal growth of Bacteroides sp., Enterococcus sp., Escherichia coli, and Enterobacter sp.
Proctoscopy

Performed

Granular rectal mucosa with moderate edema. Occasional mucosal erosions with minimal bleeding. No polyps or tumors.
Rectal biopsy

Performed

Diffuse chronic inflammatory infiltrates with lymphoid follicular hyperplasia. Erosions overlying the lymphoid follicles. No crypt distortion or abscesses.
CD4 count

Performed

998 cells/mm3 (500 - 1,200 cells/mm3)

Select Relevant Management
Reanastomosis
Short-chain fatty acid enema
Mesalamine suppository
Antibiotics