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Sugiyama T, Takeuchi Y, Kinoshita O, Mori Y, Higuchi I, Tsuchida Y. A case of colonic perforation in collagenous colitis without diarrheal symptoms.: A case report. Int J Surg Case Rep 2023; 108:108401. [PMID: 37348201 PMCID: PMC10382730 DOI: 10.1016/j.ijscr.2023.108401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Collagenous colitis is an inflammatory disease characterized by hyperplasia of the collagen band beneath the colonic mucous membrane. Chronic diarrhea is a characteristic clinical symptom. The disease is often diagnosed accidentally on colonoscopy for chronic diarrhea, and patients without chronic diarrhea have few chances to suspect the disease. PRESENTATION OF CASE The patient was a 75-year-old woman. The chief complaint was sudden upper abdominal pain and vomiting. There were no important findings regarding the consumed food or bowel habits (no diarrhea). Computed tomography revealed wall thickness and a small amount of free air around the descending colon. An emergency laparotomy was performed with the diagnosis of spontaneous colonic perforation. Intra-operative findings revealed a longitudinal ulcer and micro-perforation to the mesenterial side at the descending colon. Pathological findings revealed subepithelial collagenous band in the submucosal background of the ulcer, and which was diagnosed as collagenous colitis. DISCUSSION Intestinal perforation in collagenous colitis is extremely rare. It was considered that perforation was caused by a transient increase in intestinal pressure in the background of collagenous colitis. Further, to the best of our knowledge, this is the first report of a critical case which presented without the characteristic symptom of chronic diarrhea. CONCLUSION We report a rare case of colonic perforation of the collagenous colitis.
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Affiliation(s)
| | - Yuji Takeuchi
- Department of Digestive Surgery, Iseikai Hospital, Osaka, Japan
| | - Osamu Kinoshita
- Department of Digestive Surgery, Iseikai Hospital, Osaka, Japan
| | - Yoshihiro Mori
- Department of Digestive Surgery, Iseikai Hospital, Osaka, Japan
| | - Ichiro Higuchi
- Department of Digestive Surgery, Iseikai Hospital, Osaka, Japan
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Sadamitsu T, Ueda T, Boku E, Tanaka T, Yokoyama T, Yoshimura A. Spontaneous colonic perforation with collagenous colitis in an elderly patient. Clin J Gastroenterol 2022; 15:1083-1087. [PMID: 36251247 DOI: 10.1007/s12328-022-01707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Collagenous colitis (CC) is a variant of microscopic colitis that causes chronic, non-bloody, and watery diarrhea. The natural history of CC is generally benign and serious complications are rare. Perforation, especially spontaneous perforation, is a particularly rare complication. A 90-year-old woman presented with acute abdominal pain. She was diagnosed with peritonitis due to colonic perforation, and partial colectomy was performed. Macroscopic findings showed well-circumscribed longitudinal ulcer, and a pathological examination revealed descending colon perforation with CC. She had no history of examination and the case was considered to be spontaneous. The postoperative course was uneventful and she had no recurrence of CC after changing from the suspected drug (lansoprazole) to an H2-blocker. The characteristics of perforation by CC are characteristic longitudinal ulcer and micro-perforation. If it can be diagnosed accurately, conservative treatment may be an option. In spontaneous cases, the history of medication and the site of perforation may assist in this decision.
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Affiliation(s)
- Tomomi Sadamitsu
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
| | - Takeshi Ueda
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan.
| | - Eitetsu Boku
- Kawakami Village National Health Insurance Kawakami Clinic, 1334-23 Sako, Kawakami-mura, Yoshino-gun, 639-3553, Japan
| | - Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
| | - Takashi Yokoyama
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
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Mori H, Miyake T, Shimizu T, Yamaguchi T, Kaida S, Takebayashi K, Iida H, Otsuki A, Inatomi O, Kitoh K, Andoh A, Tani M. A case of spontaneous colonic perforation in collagenous colitis. Surg Case Rep 2019; 5:90. [PMID: 31152255 PMCID: PMC6544679 DOI: 10.1186/s40792-019-0647-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Collagenous colitis (CC) is a clinicopathologic syndrome characterized by chronic watery diarrhea and distinctive histopathologic features. Spontaneous perforation of CC is extremely rare, because CC is usually managed medically, and the need for surgical intervention is rare. We report a surgical case of spontaneous colonic perforation of CC with acute abdomen disease. CASE PRESENTATION A 77-year-old man was admitted to our hospital for abdominal pain and watery diarrhea. Computed tomography (CT) showed a thickened bowel wall with edema involving free air around the splenic flexure of the colon. Therefore, we performed emergency surgery with a diagnosis of colonic perforation. Intraoperative findings revealed colonic necrosis at the splenic flexure, so we performed a left hemicolectomy. Histopathological examination revealed typical findings of CC, a thick subepithelial collagenous band and deep ulcers with perforation. The postoperative course was uneventful, and the patient was discharged on the 28th postoperative day. After changing the proton pump inhibitor (PPI) from lansoprazole (LPZ) to rabeprazole (RPZ), he has not complained of diarrhea symptoms. CONCLUSIONS Although spontaneous perforation is a rare complication of CC, it is possible to be diagnosed by symptom of acute abdomen disease. This is the seventh case of spontaneous colonic perforation of CC worldwide.
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Affiliation(s)
- Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan.
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Akinori Otsuki
- Otsu, Japan to Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Osamu Inatomi
- Otsu, Japan to Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Katsuyuki Kitoh
- Otsu, Japan to Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Akira Andoh
- Otsu, Japan to Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-chou, Otsu, Shiga, 520-2192, Japan
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Boland K, Nguyen GC. Microscopic Colitis: A Review of Collagenous and Lymphocytic Colitis. Gastroenterol Hepatol (N Y) 2017; 13:671-677. [PMID: 29230146 PMCID: PMC5717882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by chronic watery diarrhea and diagnosed with the histologic hallmarks of disease despite a macroscopically normal large bowel. Although 2 distinct disease phenotypes exist, their clinical presentations and epidemiologic characteristics have overlapping features. This article summarizes evidence regarding the pathogenesis of MC, mechanisms of diarrhea in this cohort, and associations with medications. In addition, currently recommended and novel therapeutic approaches to achieving remission in this patient population are reviewed.
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Affiliation(s)
- Karen Boland
- Dr Boland is an inflammatory bowel disease fellow and Dr Nguyen is a clinician scientist at the Mount Sinai Hospital IBD Centre in Toronto, Canada. Dr Nguyen is also an associate professor of medicine at the University of Toronto in Toronto, Canada
| | - Geoffrey C Nguyen
- Dr Boland is an inflammatory bowel disease fellow and Dr Nguyen is a clinician scientist at the Mount Sinai Hospital IBD Centre in Toronto, Canada. Dr Nguyen is also an associate professor of medicine at the University of Toronto in Toronto, Canada
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