New challenges in the management of inflammatory bowel disease: a case study

Global estimates suggest that there are approximately 25 million transgender individuals worldwide, with about one million residing in the United States. The increasing accessibility of plastic surgery and more inclusive insurance policies have led to a rise in the number of transgender individuals opting for surgical treatments. According to 2019 research, about 28% of transgender women have undergone gender-affirming surgical procedures, with 5–13% of these surgeries involving genital reconstruction. Among transgender women who have not had gender-affirming surgery, approximately 45–54% express a desire to have such procedures in the future [1]. Often, these treatments significantly alleviate gender dysphoria, which is the distress caused by a discrepancy between a person’s experienced or expressed gender and their assigned sex at birth, thereby enhancing their quality of life. The scarcity of precise epidemiological data on gender dysphoria is probably a result of ongoing social stigma [2].
A 39-year-old transgender patient was admitted to the gastroenterology department in July 2023 with progressive weakness, weight loss (approximately 8 kg in 2 months), severe abdominal pain primarily during defecation, diarrhoea with blood (including nocturnal episodes), and vaginal bleeding. The patient had undergone surgical gender reassignment on 11 November 2021. The surgery involved the removal of external genital organs, formation of labia, creation of an external urethral opening, and separation of the sigmoid and neovaginal sections. The patient was receiving hormonal treatment under an endocrinologist’s care. Prior to the 2021 surgery, a colonoscopy had indicated normal mucosal condition. The patient also had a history of vitiligo and bronchial asthma, was married with children, and is currently in a civil partnership with a woman. In May 2023, the patient experienced loose bowel movements with blood and vaginal bleeding for the first time, accompanied by laboratory findings of thrombocythaemia (535 thousand; normal range: 150–400 thousand), peripheral eosinophilia (13.8%; N < 7), elevated IgE level (754 IU/ml; N < 100), and increased stool calprotectin level (261 µg/g). Stool cultures for pathogenic bacteria and parasites were negative. Transglutaminase antibodies were within normal limits. Due to neovaginal bleeding, the patient was also referred to a gynaecologist, who found no pathological changes.
Upon admission, the patient was diagnosed...


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