Introduction

We present a rare case of isolated cecal stricture secondary to

excessive non-steroidal anti-inflammatory drugs (NSAIDs) use

mimicking colonic mass on diagnostic imaging of the abdomen.

Isolated Cecal Stricture Secondary to NSAIDs Use Mimicking Colonic Mass

Pranav Patel1, Tejas Raiyani

1, *Adey Hasan

1, Antwan Atia

2, Ravindra Murthy

3, Mark Young

2

1Department of Internal Medicine, 2 Department of Gastroenterology, East Tennessee State University 3Department of Gastroenterology, James H Quillen VA Medical Center, Johnson City, TN, United States.

Discussion • The effects of NSAIDs on the gastrointestinal system are well established.

• NSAIDs were first reported to cause colonic stricture in 1989 and since

then at least 50 cases has been reported.

• The most common site is the proximal ascending colon. NSAIDs were

described to cause diaphragmatic colonic stricture.

• Patients who have NSAIDs induced colonic stricture can present with

features mimicking colonic malignancy or can present acutely with

perforation. We present a rare case of isolated cecal stricture caused by

NSAIDs.

Case Description • 55-year-old male presented with sharp right lower Abdominal pain of two days.

• Pain was continuous and non-radiating without nausea, vomiting, fever, chills,

hematochazia or malena.

• H/o 1-2 firm bowel movements every day , good appetite with stable body weight.

• PMH: HTN, Dyslipidemia, GERD and Tubular adenomatous colon polyps

• Physical examination : Right lower quadrant and suprapubic tenderness.

• Labs: WBC 12.3/ mcL , HgB 12.6 g/dL , Normal CMP, LFT, coagulation and iron

studies

• CT Scan Abdomen : Large 6.3X 5.6 cm mass replacing cecum suspicious for colon

cancer.

• Colonoscopy : Large circumferential ulcerated stricture in the cecum.

• Biopsies : Ulcerated mucosa and underlying granulation tissue with prominent

endothelial cells.

• A cytokeratin AE1/3 stain did not show any infiltrating tumor cells in the

ulcerated areas.

• Upon further questioning of the patient, he has been taking 3 tablets of aspirin

daily and goody’s powder twice daily chronically.

• Patient was asked to avoid NSAIDs. References 1. Lang J, Price AB, Levi AJ, Burke M, Bjarnason I. Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol 1988;41(5):516-526. 2. Klein M, Linnemann D, Rosenberg J. Non-steroidal anti-inflammatory drug-induced colopathy. BMJ Case Rep. 2011 Feb 8;2011. 3. Khan AZ, George K, DeFriend DJ. Nonsteroidal anti-inflammatory drug-induced colonic stenosis: an unusual cause of a right-sided colonic mass: report of a case. Dis Colon Rectum. 2003 Mar;46(3):403-5. 4. El Hajj I, Hawchar M, Sharara A. NSAID-induced colopathy: case report and review of the literature. J Med Liban. 2009 Oct-Dec;57(4):274-6.

Colonoscopy showing Large circumferential ulcerated stricture in the cecum

CT showing Large Mass replacing Cecum suspicious

for colon cancer.

* Presenter