Ulcerative Colitis in A Nigerian – A Case Report

Ulcerative colitis is a rare condition among Nigerians. We present a 37year old male Nigerian who presented with recurrent passage of bloody stool of seven years duration. He has been passing watery, mucoid and bloody stool of about 3 to 5 bowel motions per day with each episode lasting for about three to six weeks following which there will be remission that lasts for about 1 to 2months. There is associated tenesmus, low grade fever and abdominal pain during each episode. There is weight loss despite intact appetite. No family history of inflammatory bowel disease or colorectal cancer. He does not take alcohol nor smoke cigarette. Clinical examination was not remarkable. On digital rectal examination however, the examining finger was stained with maroon-colored blood, no rectal mass was felt. Other systems were essentially normal. Provisional diagnosis was suspected Ulcerative colitis to rule out Crohn’s disease and to rule out Colorectal cancer. Colonoscopy revealed circumferential mucosa inflammation with multiple areas of erosion and presence of numerous mucosal debris extending from the rectum to involve the sigmoid colon, descending colon, transverse colon and the ascending colon. No diverticula, no polyps or masses seen. Endoscopic features indicate Extensive Ulcerative Colitis (Proctitis with Pancolitis). Histologic sections show features consistent with Ulcerative Colitis. Upper GI Endoscopy revealed essentially normal findings. He was commenced on long-term Amino-salicylate(Mesalamine), antioxidants and a short course of antibiotics (Ofloxacin and Metronidazole). He presented at our clinic three months later with complete resolution of all the symptoms and was scheduled for regular clinic follow-up. Although ulcerative colitis is uncommon among Nigerians, a high index of suspicion with colonoscopy work-up will help to make the diagnosis.