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. 2019 May 31;5(1):90.
doi: 10.1186/s40792-019-0647-0.

A case of spontaneous colonic perforation in collagenous colitis

Haruki Mori  1 , Toru Miyake  2 , Tomoharu Shimizu  2 , Tsuyoshi Yamaguchi  2 , Sachiko Kaida  2 , Katsushi Takebayashi  2 , Hiroya Iida  2 , Akinori Otsuki  3 , Osamu Inatomi  3 , Katsuyuki Kitoh  3 , Akira Andoh  3 , Masaji Tani  2
Affiliations

A case of spontaneous colonic perforation in collagenous colitis

Haruki Mori et al. Surg Case Rep. .

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.

Keywords: Collagenous colitis; Colonic perforation; Spontaneous.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Abdominal computed tomography (CT). a Ascites around the liver (arrow). b, c Thickness in bowel wall and involving the free air around the colonic splenic flexure (arrow)
Fig. 2
Fig. 2
Macroscopy of the resected colon: cross sections of the bowel show normal-appearing mucosa, markedly thickened edematous wall, and longitudinal ulcer. The arrow indicates the perforation site
Fig. 3
Fig. 3
Histological examination. a Typical findings of collagenous colitis with a thick subepithelial collagenous band (arrowhead). b Collagenous band was stained by Azan (arrowhead). c Ulcerated area with perforation (arrow)
See this image and copyright information in PMC

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