Neoterminal Ileal Polyposis and Ulceration after Restorative Proctocolectomy with a Current Review of the Literature

After ileal pouch anal anastomosis, one of the frequently encountered complications is polyposis of the pouch. We describe a case of proximal neoterminal ileal polyposis associated with deep ulceration suggestive of Crohn’s disease and review the available literature. A 36-year-old male presented with resistant pouchitis 11 years after surgery for ulcerative colitis. With all-negative initial workup, pouchoscopy showed multiple deep ulcers in the proximal ileum with some polyps. Biopsy of polyps showed inflammatory polyps with negative immunohistological staining for IgG pouchitis. With no treatable etiology for pouchitis and the presence of inflammatory polyps, there are no guidelines for surveillance of this condition. Definitive diagnosis is challenging and there is no consensus or recommended guidelines on the management

An integrated social vulnerability assessment of riverine flood hazards in Shelby County, Tennessee

Purpose: Vulnerability studies are commonly used to inform planning, as cities and regions seek to build resilience to environmental hazards. In Shelby County, Tennessee, socioeconomic census tract data were mapped to identify the socially vulnerable population and places to underpin strategies in the Mid-South Regional Resilience Master Plan (RRMP). While this is an important step in identifying vulnerability in the county, this paper aims to enhance the local analysis through an integrated approach that considers both social factors and environmental hazards in assessing vulnerability. Design/methodology/approach: This paper conducts a social vulnerability assessment by integrating a social vulnerability index with risk exposure analysis at the census tract level to identify the population and places vulnerable to riverine flooding in Shelby County. Findings: The analysis reveals that social vulnerability assessments that do not relate socioeconomic factors to specific environmental hazards such as riverine flooding underestimate the population and places that are vulnerable. For Shelby County, this has the tendency to undermine the prioritization and effectiveness of strategies to build resilience to riverine flooding and can worsen preexisting marginalization. Practical implications: This paper recommends integrated vulnerability assessments for each of the environmental hazards identified in the Mid-South RRMP to augment existing resilience efforts in the county. Originality/value: This paper enhances the understanding of social vulnerability assessments by consolidating the need for integrated assessment frameworks as basis for resiliency planning

Febrile Neutropenia with Thrombocytopenia after Infliximab Induction in a Patient with Ulcerative Colitis

A 34-year-old female with left-sided ulcerative colitis (UC) developed severe febrile neutropenia/thrombocytopenia soon after infliximab induction therapy. There was no other plausible cause of the cell line abnormalities other than an accurate temporal association with infliximab administration. Supportive care, broad-spectrum antibiotic, and single dose of filgrastim was given on day 5 of admission due to persistently low absolute neutrophil count and fevers. The cell lines recovered, fever resolved and the patient made a complete clinical recovery. Clinicians should be aware of this potential life-threatening inflixmab side effect previously unreported in adults with UC