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Image challenge: A rare case of an intestinal ulcer

What caused a 66-year-old patient to have bloody diarrhea even after treatment with oral mesalamine and suppositories?

Gastroenterology image challenge: A 66-year-old woman presented with bloody diarrhea over two months. One month before her hospitalization, she was diagnosed with ulcerative colitis after a colonoscopy. However, despite treatment with oral mesalamine and suppositories, she continued to have bloody diarrhea. She was admitted to our hospital for further examination.

Past medical history included esophagitis, gastritis, congenital absence of left kidney and type 2 diabetes. A repeat colonoscopy (figure A, B and C) was performed, and multiple focal ulcers of different sizes could be seen, which were round or oval bulges. The blood vessels on the mucosal surface were dilated and thickened, the central erosion was sunken and white fibrous was attached, which was biopsied.

What was the diagnosis? Was it ulcerative colitis?

To find out the diagnosis, read the full case in Gastroenterology.

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