Miscellaneous Inflammatory and Structural Disorders of the Colon

Isolated Nonspecific Colonic Ulcer: A Case Report From a Tertiary Care Hospital in Pakistan

“…NSCUs have been referred by various terminologies in the previous studies such as idiopathic ulcers, cecal ulcers, simple ulcers of the colon, solitary ulcers, idiopathic ulcers, among others [1]. However, there is limited knowledge with regards to its etiology and still remains a diagnosis of exclusion [4].…”

“…NSCUs can affect all age groups; however, it is most common in the fifth decade [3] with a slight female predominance [3-4]. According to Ong et al, 67% of the ulcers occur in the cecum and the ascending colon [3], with the majority developing in the cecum near the ileocecal valve [2].…”

“…According to Ong et al, 67% of the ulcers occur in the cecum and the ascending colon [3], with the majority developing in the cecum near the ileocecal valve [2]. They usually occur as solitary lesions on the antimesenteric border on the luminal side of the colon, and may be round or oval but with sharply demarcated borders surrounded by normal colonic mucosa [4-5]. Their size and depth may vary from a few millimeters to centimeters, and from abrasions to full depth perforations [2].…”

“…According to the ischemic hypothesis, vascular abnormalities such as vascular wall thickening and thrombus formation in microvasculature can lead to vascular insufficiency resulting in the ulcer formation. This has been noted in the area surrounding the ulcer and could explain its location on the antimesenteric border, however, if ischemia were to be the cause then the majority of the ulcers would have developed in the watershed areas (descending colon and the sigmoid colon) rather than in the cecum [4].…”

“…Another proposed mechanism lists diverticulosis as the potential cause as cecal diverticula have been observed in cases with NSCUs. Again, the facts that go against this theory are that cecal diverticula usually form on the mesenteric border (rather than the antimesenteric border as is the case with NSCUs) and furthermore are prevalent in the sigmoid colon as opposed to the cecum [4].…”