Irina Ciortescu Roxana Nemteanu Liliana Gheorghe Corina Hincu Liliana Fortu Oreste Chiriac Andreea Clim Alina Plesa


Ulcerative colitis (UC) is a chronic inflammatory condition, with a relapsing-remitting course. The case presented poses some valid questions regarding short-term and long-term management of patients with UC, and if the outcome (colectomy) could have been delayed or even prevented. Rectal bleeding is a cardinal symptom in patients with UC and it occurs among all patients during active disease. Massive rectal bleeding is an uncommon, but serious, complication of UC accounting for 0.1-1.4% of admissions. It is, nonetheless, noteworthy that instances of acute significant lower gastrointestinal bleeding accompanied by hemodynamic instability are infrequent. The rate of colectomy appears to be positively impacted by biological treatment. However, a refractory condition is still the primary reason for surgery, indicating a pressing need for new treatment approaches. Here we present the case of a young male patient who developed massive rectal bleeding and underwent emergent colectomy with ileostomy while having clinical and biological remission (normal calprotectin levels) at week 10 of Vedolizumab treatment.



ulcerative colitis, massive rectal bleeding, emergency colectomy, calprotectin value

1. Gallo G, Kotze PG, Spinelli A. Surgery in ulcerative colitis: When? How? Best Pract Res Clin Gastroenterol. 2018;32-33:71-78. doi: 10.1016/j.bpg.2018.05.017. PMID: 30060941.
2. Miranda-Bautista J, Diéguez L, Rodríguez-Rosales G, Marín-Jiménez I, Menchén L. Cases report: severe colonic bleeding in ulcerative colitis is refractory to selective transcatheter arterial embolization. BMC Gastroenterol. 2019;19(1):55. doi: 10.1186/s12876-019-0970-8. PMID: 30991964; PMCID: PMC6469077.
3. Kolehmainen S, Lepistö A, Färkkilä M. Impact of anti-TNF-alpha therapy on colectomy rate and indications for colectomy in ulcerative colitis: comparison of two patient cohorts from 2005 to 2007 and from 2014 to 2016. Scand J Gastroenterol. 2019;54(6):707-711. doi: 10.1080/00365521.2019.1620326. PMID: 31136207.
4. Pardi DS, Loftus EV Jr, Tremaine WJ, et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc. 1999;49(2):153-7. doi: 10.1016/s0016-5107(99)70479-7. PMID: 9925691.
5. Macaluso FS, Cavallaro F, Felice C, et al. Risk factors and timing for colectomy in chronically active refractory ulcerative colitis: A systematic review. Dig Liver Dis. 2019;51(5):613-620. doi: 10.1016/j.dld.2019.01.018. PMID: 30826279.
6. Farmer RG, Easley KA, Rankin GB. Clinical patterns, natural history, and progression of ulcerative colitis. A long-term follow-up of 1116 patients. Dig Dis Sci. 1993;38(6):1137-1146. doi: 10.1007/BF01295733. PMID: 8508710.
7. Leijonmarck CE, Persson PG, Hellers G. Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study. Gut. 1990;31(3):329-33. doi: 10.1136/gut.31.3.329. PMID: 2323599; PMCID: PMC1378277.
8. Rodríguez C, Elosua A, Prieto C, et al. Colectomy rate in ulcerative colitis 15 years after diagnosis: Results from the 2001-2003 Navarra cohort. Gastroenterol Hepatol. 2022;45(1):1-8. English, Spanish. doi: 10.1016/j.gastrohep.2020.11.016. PMID: 33545242.
9. Henriksen M, Jahnsen J, Lygren I, et al. Ulcerative colitis and clinical course: results of a 5-year population-based follow-up study (the IBSEN study). Inflamm Bowel Dis. 2006;12(7):543-550. doi: 10.1097/01.MIB.0000225339.91484.fc. PMID: 16804390.
10. Sahami S, Konté K, Buskens CJ, et al. Risk factors for proximal disease extension and colectomy in left-sided ulcerative colitis. United European Gastroenterol J. 2017;5(4):554-562. doi: 10.1177/2050640616679552. PMID: 28588887; PMCID: PMC5446151.
11. Wilkens R, Dolinger M, Burisch J, Maaser C. Point-of-Care Testing and Home Testing: Pragmatic Considerations for Widespread Incorporation of Stool Tests, Serum Tests, and Intestinal Ultrasound. Gastroenterology. 2022;162(5):1476-1492. doi: 10.1053/j.gastro.2021.10.052. PMID: 34995530.
12. Khaki-Khatibi F, Qujeq D, Kashifard M, et al. Calprotectin in inflammatory bowel disease. Clin Chim Acta. 2020;510:556-565. doi: 10.1016/j.cca.2020.08.025. PMID: 32818491; PMCID: PMC7431395.
13. Malvão LDR, Madi K, Esberard BC, et al. Fecal calprotectin as a noninvasive test to predict deep remission in patients with ulcerative colitis. Medicine (Baltimore). 2021;100(3):e24058. doi: 10.1097/MD.0000000000024058. PMID: 33546007; PMCID: PMC7837839.
14. Vicente-Steijn R, Jansen JM, Bisheshar R, Haagen IA. Analytical and clinical performance of the fully-automated LIAISONXL calprotectin immunoassay from DiaSorin in IBD patients. Pract Lab Med. 2020;21:e00175. doi: 10.1016/j.plabm.2020.e00175. PMID: 32637525; PMCID: PMC7327250.
15. Henriksen M, Jahnsen J, Lygren I, et al C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut. 2008;57(11):1518-1523. doi: 10.1136/gut.2007.146357. PMID: 18566104.
16. Mak LY, Tong TSM, Cheung KS, et al. Combined Use of Common Fecal and Blood Markers for Detection of Endoscopically Active Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2020;11(3):e00138. doi: 10.14309/ctg.0000000000000138. PMID: 32132451; PMCID: PMC7145039.
17. Kedia S, Ahuja V, Tandon R. Management of acute severe ulcerative colitis. World J Gastrointest Pathophysiol. 2014;5(4):579-588. doi: 10.4291/wjgp.v5.i4.579. PMID: 25401001; PMCID: PMC4231522.
18. Holvoet T, Lobaton T, Hindryckx P. Optimal Management of Acute Severe Ulcerative Colitis (ASUC): Challenges and Solutions. Clin Exp Gastroenterol. 2021;14:71-81. doi: 10.2147/CEG.S197719. PMID: 33727846; PMCID: PMC7955027.
19. Croft A, Lord A, Radford-Smith G. Markers of Systemic Inflammation in Acute Attacks of Ulcerative Colitis: What Level of C-reactive Protein Constitutes Severe Colitis? J Crohns Colitis. 2022;16(7):1089-1096. doi: 10.1093/ecco-jcc/jjac014. PMID: 35147694; PMCID: PMC9351978.
20. Bregnbak D, Mortensen C, Bendtsen F. Infliximab and complications after colectomy in patients with ulcerative colitis. J Crohns Colitis. 2012;6(3):281-286. doi: 10.1016/j.crohns.2011.08.014. PMID: 22405163.
21. Teeuwen PH, Stommel MW, Bremers AJ, et al. Colectomy in patients with acute colitis: a systematic review. J Gastrointest Surg. 2009;13(4):676-686. doi: 10.1007/s11605-008-0792-4. PMID: 19132451.
22. Sandborn WJ, Colombel JF, Panaccione R, et al. Deep Remission With Vedolizumab in Patients With Moderately to Severely Active Ulcerative Colitis: A GEMINI 1 post hoc Analysis. J Crohns Colitis. 2019;13(2):172-181. doi: 10.1093/ecco-jcc/jjy149. PMID: 30285104; PMCID: PMC6357899.
23. Hanžel J, Sever N, Ferkolj I, et al. Early vedolizumab trough levels predict combined endoscopic and clinical remission in inflammatory bowel disease. United European Gastroenterol J. 2019;7(6):741-749. doi: 10.1177/2050640619840211. PMID: 31316778; PMCID: PMC6620872.
How to Cite
Emergency colectomy for massive rectal bleeding in a patient with well-controlled ulcerative colitis receiving Vedolizumab. (2023). Archive of Clinical Cases, 10(3), Arch Clin Cases. 2023;10(3):133-137.
Case Reports

How to Cite

Emergency colectomy for massive rectal bleeding in a patient with well-controlled ulcerative colitis receiving Vedolizumab. (2023). Archive of Clinical Cases, 10(3), Arch Clin Cases. 2023;10(3):133-137.