What is the significance of colitis in the transverse and descending colon, with elevated White Blood Cell (WBC) count, mild anemia, and normal hematocrit, prompting a follow-up colonoscopy to rule out underlying malignancy?

From the Guidelines

I strongly recommend a follow-up colonoscopy after the resolution of colitis to rule out underlying malignancy, as suggested by the CT report, due to the potential for colonic neoplasms to be masked by inflammatory changes 1. The patient's slightly elevated white blood cell count (11.2) suggests an inflammatory or infectious process, which is consistent with the CT findings of colitis in the transverse and descending colon. The red blood cell count and hematocrit are within normal limits, which is a positive sign. Some key points to consider in the management of this patient include:

• The importance of excluding underlying malignancy after an episode of colitis, as the absence of a mass lesion on CT scan does not exclude the possibility of an underlying colonic neoplasm 1.
• The potential benefits of colonoscopy in detecting colorectal cancers and advanced adenomas, as observed in observational studies of patients with imaging-proven diverticulitis who subsequently underwent colonoscopy 1.
• The need for careful consideration of the timing and completeness of prior colonoscopy, comorbidities, persistent symptoms, and patient preferences when deciding to perform a colonoscopy after an episode of colitis 1.
• The potential risks of colonoscopy, particularly in patients with chronic or complicated diverticulitis, and the importance of weighing these risks against the benefits of the procedure 1. During treatment, it is essential to monitor for improvement in symptoms such as abdominal pain, diarrhea, and fever. If symptoms worsen or don't improve within 48-72 hours of antibiotic therapy, seek immediate medical attention as this could indicate a more serious condition requiring hospitalization. The European evidence-based consensus for endoscopy in inflammatory bowel disease also supports the use of endoscopy in acute colitis, particularly for diagnosis and excluding other causes of acute colitis 1. However, the most recent and highest quality study relevant to this patient's situation is the American Gastroenterological Association Institute guideline on the management of acute diverticulitis, which recommends colonoscopy after resolution of acute diverticulitis to exclude underlying malignancy 1.

From the Research

Patient's Condition

The patient has been diagnosed with colitis of the transverse and descending colon based on a CT abdomen scan. The patient's blood test results show a white blood cell count of 11.2, red blood cell count of 5.43, and hematocrit of 46.1.

Recommended Follow-up

A follow-up colonoscopy is recommended upon resolution of the colitis to rule out underlying malignancy. This is a common practice in patients with inflammatory bowel disease (IBD) to monitor for potential complications such as dysplasia or cancer 2.

Treatment Options

The treatment options for ulcerative colitis (UC) depend on the extent and severity of the disease. For mild to moderate cases, topical 5-aminosalicylic acid (5-ASA) drugs or oral corticosteroids may be used to induce remission 3, 4. In more severe cases, hospitalization and treatment with intravenous steroids or biologics such as tumor necrosis factor-α antibodies may be necessary 3, 5.

Importance of Colonoscopy

Colonoscopy with biopsy is the gold standard for diagnosing UC and monitoring disease activity 3, 2. It allows for the assessment of the extent and severity of inflammation, as well as the detection of dysplasia or cancer. A short course of corticosteroids prior to surveillance colonoscopy may help decrease mucosal inflammation and improve the accuracy of biopsy results 6.

Key Considerations

• The patient's elevated white blood cell count and red blood cell count may indicate active inflammation, which should be monitored and treated accordingly.
• The patient's hematocrit level is within normal range, which suggests that there is no significant anemia at present.
• The recommended follow-up colonoscopy should be scheduled once the patient's symptoms have resolved, to minimize the risk of complications and improve the accuracy of the procedure.