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.