Background
Collagenous colitis (CC) is a microscopic colitis characterized by
watery diarrhea without bloody stool [1]. CC often occurs in
middle-aged females. Smoking and the use of medication of proton pump
inhibitors (PPI) and nonsteroidal anti-inflammatory drugs (NSAIDs) are
known risk factors [2]. The main treatment for CC is the
discontinuing of medication and smoking cessation. Medication therapies
such as glucocorticoids, budesonide and prednisone are added to the
active state of the disease [3]. Very few patients are refractory to
drug treatment and require surgical treatment [4].
Herein, we report the case of a 58-year-old female who underwent
emergency surgery for colonic perforation due to CC.
Case Presentation: A 58-year-old female, complaining of
constant abdominal pain presented to the hospital. There were no
symptoms of diarrhea. Her past medical history was hypertension,
insomnia, constipation, and a 38-year smoking history. Her medications
at presentation were lansoprazole, irbesartan, amlodipine besilate, and
etizolam. She has been on these medication for several year. As computed
tomography (CT) detected colon perforation, she was transferred to our
hospital for surgery and intensive care. Her vital signs on arrival were
as follows: blood pressure, 114/60 mmHg; pulse rate, 60/min, oxygen
saturation, 99% on room air, and body temperature 37.2 degree in
Celsius. Physical examination revealed left lower abdominal tenderness
and rebound tenderness. The laboratory tests results were as follows:
white blood cell counts of 11,500/μL; C-reactive protein, 1.95 mg/dl. An
abdominal CT scan showed a thickened descending colon, accompanied by
free air (Fig. 1). An emergency laparotomy was performed. The was a few
purulent ascites in the abdomen. Although no obvious perforation site
was identified, the descending colon was thickened and suspected to be
the cause of perforation. Thus, partial colon resection and covering
-ileostomy were performed. The anastomosis was performed by functional
end-to-end anastomosis. Three 19Fr drains were placed in the abdomen,
and the operation was completed. Macroscopic examination of the resected
colon revealed a longitudinal ulcer and no diverticulum (Fig. 2). The
length of ulcer was 7.5 centimeters. Histopathological examination
revealed a colonic subepithelial collagen band in the superficial
epithelium on hematoxylin and eosin (HE) staining, which showed an
edematous appearance of the submucosa and a generalized neutrophilic
infiltrate, and CC was diagnosed (Fig. 3). Antibiotic therapy was
continued for five postoperatively. Drains were removed on postoperative
day 5. The patient was discharged without complications on postoperative
day 9. There was no diverticulum or inflammatory bowel disease on
histopathological examination. PPI therapy was thought cause of CC, and
lansoprazole was changed to famotidine. After discharge from the
hospital, she had no recurrence of abdominal pain of new-onset watery
diarrhea. Ileostomy closure was performed 3 months after discharge.