Ulcerative colitis in the autotransplanted neovagina.

A 33-year-old woman had undergone a radical surgical excision for carcinoma of the vagina at age 11. Vaginal reconstruction using a pedicled transplant of the sigmoid colon was successfully accomplished at age 19. Fourteen years later she developed vaginal bleeding, and a biopsy of the neovagina revealed changes consistent with ulcerative colitis. Within 2 weeks the patient developed bleeding per ano, and a rectal biopsy also revealed changes consistent with ulcerative colitis. Symptoms responded to sulfasalazine. This is believed to be the first case report of ulcerative colitis developing in colonic tissue used for a neovagina. The etiology, natural history, and surveillance of ulcerative colitis in relation to this unique case are reviewed. This case argues against the hypothesis that chronic ulcerative colitis is causally related to direct exposure to alimentary antigens.