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Retroperitoneal fibrosis during the course of ulcerative colitis. A simple coincidence?
I A Mouzas1, P Anezinis, S Karampekios
1Department of Gastroenterology, University Hospital, Heraklion, Greece. mouzas@med.uoc.gr
Abstract:
Retroperitoneal fibrosis has been described as a rare occurrence during the course of inflammatory bowel disease, mainly Crohn's disease. This is the third report on retroperitoneal fibrosis occurring during the course of ulcerative colitis. A 62-year-old male patient with a 5-year history of ulcerative colitis developed stenosis of the left ureter due to retroperitoneal fibrosis. Treatment consisted in surgically releasing the ureter from the mass and steroids. During a 2.5-year follow-up, renal function was stable and ulcerative colitis in remission. Important aspects of this case are the moderate course of ulcerative colitis, ultrasound confirmation of normal kidney structure before manifestation of fibrosis, hypertension diagnosed four years before retroperitoneal fibrosis, a non-functioning kidney at diagnosis, and reduction of retroperitoneal mass after steroid treatment. Retroperitoneal fibrosis, although a rare disease entity should be considered when a patient with ulcerative colitis develops otherwise unexplained renal insufficiency.
Insights
Retroperitoneal fibrosis is a rare complication of ulcerative colitis. This case highlights its potential to cause ureteral obstruction and emphasizes considering it in patients with unexplained renal insufficiency.
Area of Science:
- Gastroenterology and Urology
- Nephrology
Background:
- Retroperitoneal fibrosis (RPF) is an uncommon condition, primarily associated with inflammatory bowel disease (IBD), particularly Crohn's disease.
- While RPF is rare in ulcerative colitis (UC), this report details a third case, underscoring the need for awareness.
Observation:
- A 62-year-old male with a 5-year history of UC presented with left ureteral stenosis caused by RPF.
- Pre-existing hypertension and a non-functioning kidney at diagnosis were noted, alongside normal kidney structure on ultrasound prior to RPF manifestation.
- The patient had a moderate course of UC, which was in remission at follow-up.
Findings:
- Surgical release of the ureter and steroid treatment were administered.
- A 2.5-year follow-up showed stable renal function and UC remission.
- Significant reduction of the retroperitoneal mass was observed after steroid treatment.
Implications:
- This case suggests RPF should be considered in UC patients experiencing unexplained renal insufficiency.
- Early recognition and management of RPF in UC can lead to stable renal function and disease remission.