Mucosal tears and colonic perforation in a patient with collagenous colitis

Eijk, Rachel L. A. van; Bac, Dirk Jan

doi:10.1055/s-0033-1359157

Cited by 6 publications

(3 citation statements)

References 2 publications

(4 reference statements)

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“…Endoscopic evaluation of the colon can be normal, however, erythema, edema, change in vascularity, mucosal tears, and nodularity have been described. 2 , 52 – 54 …”

Section: Collagenous Colitismentioning

confidence: 99%

Optimal management of collagenous colitis: a review

O’Toole¹

2016

CEG

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Collagenous colitis (CC) is an increasingly recognized cause of chronic inflammatory bowel disease characterized by watery non-bloody diarrhea. As a lesser studied inflammatory bowel disease, many aspects of the CC’s natural history are poorly understood. This review discusses strategies to optimally manage CC. The goal of therapy is to induce clinical remission, <3 stools a day or <1 watery stool a day with subsequent improved quality of life (QOL). Antidiarrheal can be used as monotherapy or with other medications to control diarrhea. Budesonide therapy has revolutionized treatment and is superior to prednisone, however, the treatment is associated with high-relapse rates and the management of refractory disease is challenging. Ongoing trials will address the safety and efficacy of low-dose maintenance therapy. For those with refractory disease, case reports and case series support the role of biologic agents. Diversion of the fecal stream normalizes colonic mucosal changes and ileostomy may be considered where anti-tumor necrosis factor (TNF)-α agents are contraindicated. Underlying celiac disease, bile salt diarrhea, and associated thyroid dysfunction should be ruled out. The author recommends smoking cessation as well as avoidance of nonsteroidal anti-inflammatories as well as other associated medications.

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“…Endoscopic evaluation of the colon can be normal, however, erythema, edema, change in vascularity, mucosal tears, and nodularity have been described. 2 , 52 – 54 …”

Section: Collagenous Colitismentioning

confidence: 99%

Optimal management of collagenous colitis: a review

O’Toole¹

2016

CEG

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“…Although the first reported case of perforation was of the spontaneous type [ 4 ], subsequent reports have shown procedure-related perforations to be more frequent, with at least 22 reported cases [ 1 , 10 ]. Patients with procedure-related perforations are mainly elderly women with a history of chronic diarrhea, with perforation occurring during the intervention or up to seven days afterwards [ 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Collagenous colitis presenting as spontaneous perforation in an 80 year old woman: Report of a Case

Mitchell

Dugas

2016

BMC Gastroenterol

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BackgroundPerforation of the colon occurring during or shortly following colonoscopy or barium enema is a rare complication of collagenous colitis (CC). "Spontaneous" perforation in CC, in which no instigating factor is identified, is even less common, with only five cases reported to date. We report herein an additional case of spontaneous perforation in previously undiagnosed CC and review the clinical and pathological features of previously reported cases.Case presentationAn 80 year old woman presented to the emergency department with abdominal pain preceded by approximately one month of frequent non-bloody diarrhea. Abdominal CT showed parietal thickening of the colon at the splenic flexure with pneumatosis and signs of perforation. Segmental resection was performed. Pathologic examination showed the microscopic findings typical of CC complicated by several deep ulcers and perforation. One day following discharge from hospital abdominal pain and frequent non-bloody diarrhea recurred. The patient was managed conservatively and treated with oral budesonide with resulting resolution of symptoms.ConclusionsSpontaneous perforation is a rare and serious complication of CC. All patients to date have been female. In contrast to procedure-related perforation, which favors the right colon, spontaneous perforation in CC has in all cases involved the left colon. Knowledge of spontaneous perforation as a potential complication of previously undiagnosed CC may be helpful in the evaluation and management of patients presenting with colonic perforation, especially those with risk factors for CC.

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“…Linear mucosal defects may be related to lansoprazole-associated collagenous colitis in Japanese cases [40], but it still remains controversial as to whether it can be commonly applied to cases of other areas. In a case of CC, severe mucosal fractures and even a perforation have been reported [41]. A caveat for these finding is that they may also appear in non-MC cases, and therefore the disease sensitivity is not guaranteed.…”

Section: Diagnosis Of MCmentioning

confidence: 99%

Diagnosis and treatment of microscopic colitis

Okamoto

Negi

Tomii

et al. 2016

Clin J Gastroenterol

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Microscopic colitis (MC) designates two types of chronic diarrhea diseases, which are lymphocytic colitis and collagenous colitis. The prevalence of microscopic colitis is increasing in both Western and Eastern countries, possibly due to the high incidence of colonoscopic survey in chronic diarrhea patients. Although the overall prognosis of MC patients is mostly good, it should be noted that appropriate diagnosis and choice of treatment is required to assure a good clinical outcome for MC patients. Also, a certain population of MC patients may take a severe and refractory clinical course, and thus require advanced clinical care using medications supported by less evidence. In this review, we would like to feature the essential points regarding the diagnosis of MC, and also describe the current standard of treatments for MC patients. In addition, we would like to add some findings from the national survey and research carried out in Japan, to compare those data with the western countries.

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Mucosal tears and colonic perforation in a patient with collagenous colitis

Cited by 6 publications

References 2 publications

Optimal management of collagenous colitis: a review

Optimal management of collagenous colitis: a review

Collagenous colitis presenting as spontaneous perforation in an 80 year old woman: Report of a Case

Diagnosis and treatment of microscopic colitis

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