Case Report CatScratchColon · 2 Diagnostic and Therapeutic Endoscopy Figure 1 Figure 2...
3
Hindawi Publishing Corporation Diagnostic and Therapeutic Endoscopy Volume 2011, Article ID 875941, 2 pages doi:10.1155/2011/875941 Case Report Cat Scratch Colon M. Lourdes Ruiz-Rebollo, 1 Benito Velayos-Jim´ enez, 1 Jos´ e Mar´ ıa Prieto de Paula, 2 Mar´ ıa ´ Alvarez Qui˜ nones, 3 and Jos´ e Manuel Gonz ´ alez Hern ´ andez 1 1 Hepatogastroenterology Department, Clinical University Hospital, Valladolid, Spain 2 Internal Medicine Department, Clinical University Hospital, Valladolid, Spain 3 Pathology Department, Clinical University Hospital, Valladolid, Spain Correspondence should be addressed to M. Lourdes Ruiz-Rebollo, [email protected] Received 18 January 2011; Accepted 2 March 2011 Academic Editor: Spiros D. Ladas Copyright © 2011 M. Lourdes Ruiz-Rebollo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Over the past few years, we have read several publications regarding the term “cat scratch colon.” This neologism was developed to define some bright red linear markings seen in the colonic mucosa that resemble scratches made by a cat. We would like to communicate a recent case attended at our institution. A 67-year-old man with abdominal pain was referred to our unit for colonoscopy. He was a heavy smoker and a moderate drinker. He suffered from peripheral vascular disease and was treated with pentoxifylline and acetyl salicylic acid. He had been operated on his stomach due to a gastric peptic perforation years ago; he had a pulmonary benign tumour resected and a hepatic hydatid cyst removed several years ago. No abnormalities were seen in a general analysis. The colonoscopy was performed after standard bowel prepara- tion and sedation (midazolam and meperidine). The total procedure was not traumatic, and no excess air insufflation was used. There was a small polyp in the left colon. However, on entering the cecal area, several bright linear marks were seen in the mucosa (Figures 1 and 2) with some extravasation of fresh blood. A couple of biopsies were taken which were informed as normal. The polyp resected on withdrawal was adenomatous. The remainder of the colorectal mucosa was macroscopically normal. “Cat scratch colon” is defined as bright erythematous linear marks, sometimes with extravasation of little fresh blood, seen in the cecum and in ascending colon. It is a rare colonoscopy finding first described by McDonnell et al. in 2006 [1]. The authors reviewed 8277 colonoscopies performed in a single endoscopy center and identified 21 cases, mainly female patients. All these patients were biopsied and normal findings were seen in histological spec- imens except in 2 of them, where collagenous colitis was described. The etiology is not well known. Vascular malforma- tions do not play a role, and inflammation is not seen in the biopsies taken. The lesions are not due to direct scope trauma. We detected them, as other authors did, previous to the intubation of the area affected. McDonnell et al. suggested these scratches can represent barotraumas from air insufflation into a less compliant colon during the colonoscopy. Distension and traction during a special difficult procedure can be the cause, as hemorrhagic colonic mucosa can occasionally be seen in such cases [2]. Tominaga et al. [3] published two nice pictures of a female patient: a first gentle intubation of the ascending colon was performed, where colonic mucosa was normal. A second, more difficult one—in the same procedure—was done in which these mucosal superficial breaks appeared. This supports the evidence of a barotrauma etiology. There is also an interesting paper published by Cruz- Correa et al. [4], where they describe these lacerations in 3 patients affected of collagenous colitis. Their etiological hypothesis is a combination of a less compliant colon due to the thick collagen submucosa layer and endoscopic insufflation. However, Yarze [5] argues that collagen does not play such a main role. In his opinion, the lacerations could just be explained with Laplace’s law (“the tension in the wall
Transcript of Case Report CatScratchColon · 2 Diagnostic and Therapeutic Endoscopy Figure 1 Figure 2...
-
Hindawi Publishing CorporationDiagnostic and Therapeutic EndoscopyVolume 2011, Article ID 875941, 2 pagesdoi:10.1155/2011/875941
Case Report
Cat Scratch Colon
M. Lourdes Ruiz-Rebollo,1 Benito Velayos-Jiménez,1 José Marı́a Prieto de Paula,2
Marı́a Álvarez Quiñones,3 and José Manuel González Hernández1
1 Hepatogastroenterology Department, Clinical University Hospital, Valladolid, Spain2 Internal Medicine Department, Clinical University Hospital, Valladolid, Spain3 Pathology Department, Clinical University Hospital, Valladolid, Spain
Correspondence should be addressed to M. Lourdes Ruiz-Rebollo, [email protected]
Received 18 January 2011; Accepted 2 March 2011
Academic Editor: Spiros D. Ladas
Copyright © 2011 M. Lourdes Ruiz-Rebollo et al. This is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work isproperly cited.
Over the past few years, we have read several publications regarding the term “cat scratch colon.” This neologism was developedto define some bright red linear markings seen in the colonic mucosa that resemble scratches made by a cat. We would like tocommunicate a recent case attended at our institution.
A 67-year-old man with abdominal pain was referred to ourunit for colonoscopy. He was a heavy smoker and a moderatedrinker. He suffered from peripheral vascular disease andwas treated with pentoxifylline and acetyl salicylic acid. Hehad been operated on his stomach due to a gastric pepticperforation years ago; he had a pulmonary benign tumourresected and a hepatic hydatid cyst removed several yearsago. No abnormalities were seen in a general analysis. Thecolonoscopy was performed after standard bowel prepara-tion and sedation (midazolam and meperidine). The totalprocedure was not traumatic, and no excess air insufflationwas used. There was a small polyp in the left colon. However,on entering the cecal area, several bright linear marks wereseen in the mucosa (Figures 1 and 2) with some extravasationof fresh blood. A couple of biopsies were taken which wereinformed as normal. The polyp resected on withdrawal wasadenomatous. The remainder of the colorectal mucosa wasmacroscopically normal.
“Cat scratch colon” is defined as bright erythematouslinear marks, sometimes with extravasation of little freshblood, seen in the cecum and in ascending colon. It isa rare colonoscopy finding first described by McDonnellet al. in 2006 [1]. The authors reviewed 8277 colonoscopiesperformed in a single endoscopy center and identified21 cases, mainly female patients. All these patients werebiopsied and normal findings were seen in histological spec-
imens except in 2 of them, where collagenous colitis wasdescribed.
The etiology is not well known. Vascular malforma-tions do not play a role, and inflammation is not seenin the biopsies taken. The lesions are not due to directscope trauma. We detected them, as other authors did,previous to the intubation of the area affected. McDonnellet al. suggested these scratches can represent barotraumasfrom air insufflation into a less compliant colon duringthe colonoscopy. Distension and traction during a specialdifficult procedure can be the cause, as hemorrhagic colonicmucosa can occasionally be seen in such cases [2]. Tominagaet al. [3] published two nice pictures of a female patient: afirst gentle intubation of the ascending colon was performed,where colonic mucosa was normal. A second, more difficultone—in the same procedure—was done in which thesemucosal superficial breaks appeared. This supports theevidence of a barotrauma etiology.
There is also an interesting paper published by Cruz-Correa et al. [4], where they describe these lacerations in3 patients affected of collagenous colitis. Their etiologicalhypothesis is a combination of a less compliant colondue to the thick collagen submucosa layer and endoscopicinsufflation. However, Yarze [5] argues that collagen does notplay such a main role. In his opinion, the lacerations couldjust be explained with Laplace’s law (“the tension in the wall
mailto:[email protected]
-
2 Diagnostic and Therapeutic Endoscopy
Figure 1
Figure 2
of a cylindrical vessel is proportional to the ratio”). The rightcolon and the cecum have the greatest diameter.
Some other authors such as Baudet et al. [6] observedthis type of lesion related to diversion colitis. They foundlacerations on withdrawing the air from a rectal stump.In their opinion, these findings confirm the barotraumaetiology in an otherwise altered, less compliant colonicmucosa. This hypothesis is similar to Cruz-Correa’s.
However, although this colonic sign is consider benign,Purnak et al. [7] have recently described a 50-year-oldpatient with chronic cholestasis due to cholangiocellularcarcinoma with these special linear marks. They hypothe-sized an epithelial disruption and tendency to bleed due tovitamin A and K deficiency and impair gut’s barrier in thehuge intestinal oxidative stress which occurs in obstructivejaundice. Katsinelos et al. [8] observed a 73-year-old mansuffering from metastatic liver disease with these bright linearmarks on the ascending colon. They suggest that barotraumatogether with a less compliant right colon due to the pressurefrom the liver could have played a role. There are also someother hypothesis such as chronic anti-inflammatory drugingestion as recently reported in a Spanish publication [9].
We agree with previous authors that the lesions in ourpatient can be due to barotraumas. Furthermore, heavysmoking and microvascular disease in this patient added tothe ingestion of acetyl salicylic acid, which could have playeda role to their development.
References
[1] W. M. McDonnell, F. Loura, M. J. Pointon, and J. K. Greenson,“Cat scratch colon,” Endoscopy, vol. 39, no. 5, pp. 459–461,2007.
[2] D. M. Felig, M. H. Brand, and R. J. Vender, “Unexpectedright colon mucosal bleeding on colonoscopy,” GastrointestinalEndoscopy, vol. 44, no. 4, pp. 471–473, 1996.
[3] K. Tominaga, F. Shigiyama, S. Ito, T. Iida, S. Fujinuma,and I. Maetani, “Emergence of ”cat scratch colon” during acolonoscopy,” Endoscopy, vol. 40, no. 4, article 353, 2008.
[4] M. Cruz-Correa, F. Milligan, F. M. Giardiello et al., “Collage-nous colitis with mucosal tears on endoscopic insufflation: aunique presentation,” Gut, vol. 51, no. 4, article 600, 2002.
[5] J. C. Yarze, “Finding mucosal tears in collagenous colitis duringcolonoscopic insufflation,” Gut, vol. 52, no. 4, pp. 613–614,2003.
[6] J. S. Baudet, D. Diaz-Bethencourt, X. Arguiñarena, M. Soler,S. Morales, and J. Avilés, “Cat scratch colon is caused bybarotrauma secondary to insufflation during colonoscopy,”Endoscopy, vol. 40, no. 10, article 878, 2008.
[7] T. Purnak, E. Ozaslan, A. Yildiz, and C. Efe, “The cat scratchcolon sign in a patient with chronic cholestasis,” Endoscopy, vol.42, supplement 2, p. E117, 2010.
[8] P. Katsinelos, J. Kountouras, G. Chatzimavroudis, C. Zavos,and G. Paroutoglou, “”Cat scratch” colon: an impressive butinnocent endoscopic finding,” Endoscopy, vol. 39, no. 11, article1026, 2007.
[9] G. Payeras, R. Briz, R. Barranco, A. Calvache, and P. Castro,“Colon en arañazo de gato: nueva aportación etiopatogénica,”Revista Española de Enfermedades Digestivas, vol. 102, no. 12,pp. 720–721, 2010.
-
Submit your manuscripts athttp://www.hindawi.com
Stem CellsInternational
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
MEDIATORSINFLAMMATION
of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Behavioural Neurology
EndocrinologyInternational Journal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Disease Markers
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
BioMed Research International
OncologyJournal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Oxidative Medicine and Cellular Longevity
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
PPAR Research
The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014
Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Journal of
ObesityJournal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Computational and Mathematical Methods in Medicine
OphthalmologyJournal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Diabetes ResearchJournal of
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Research and TreatmentAIDS
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Gastroenterology Research and Practice
Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014
Parkinson’s Disease
Evidence-Based Complementary and Alternative Medicine
Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com
