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Spontaneous perforation in collagenous colitis

2012; Elsevier BV; Volume: 155; Issue: 1 Linguagem: Inglês

10.1016/j.surg.2012.10.008

1532-7361

Shintaro Akamoto, Masao Fujiwara, Keiichi Okano, Yasuyuki Suzuki,

Diverticular Disease and Complications

Fig 1. Contrast-enhanced computed tomography of the abdomen indicating edema (arrow) and gas (arrowhead) within the bowel wall of the descending colon. A 64-YEAR-OLD WOMAN with a history of depression treated by mianserin was admitted to our hospital with acute abdominal pain. She had no history of other drug use. Abdominal tenderness with peritoneal signs was observed in the left upper quadrant. This was preceded for 2 weeks by nonbloody diarrhea and appetite loss. Laboratory tests indicated a leukocyte count of 11,930/mm and a C-reactive protein level of 13.69 mg/dL. Contrast-enhanced computed tomography of the abdomen indicated edema and gas within the bowel wall of the descending colon (Fig 1). Ischemic colitis and necrosis of the descending colon were suspected, and an emergency laparotomy was performed. Gas bubbles were detected in the mesentery and subserous layer of the descending colon. Wall thickening and an inflammatory change were also detected, but there were no macroscopic signs of peritonitis or necrosis in the descending colon. Left-sided colectomy and transverse colostomy were performed. Grossly, the specimen exhibited multiple longitudinal ulcers. Histopathologic examination indicated typical findings of collagenous colitis (CC) with a thick subepithelial collagenous band and an ulcerated area with mesentery penetration (Fig 2). The postoperative course was uneventful.