SpringerLink
Log in

Spontaneous colonic perforation with collagenous colitis in an elderly patient

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Collagenous colitis (CC) is a variant of microscopic colitis that causes chronic, non-bloody, and watery diarrhea. The natural history of CC is generally benign and serious complications are rare. Perforation, especially spontaneous perforation, is a particularly rare complication. A 90-year-old woman presented with acute abdominal pain. She was diagnosed with peritonitis due to colonic perforation, and partial colectomy was performed. Macroscopic findings showed well-circumscribed longitudinal ulcer, and a pathological examination revealed descending colon perforation with CC. She had no history of examination and the case was considered to be spontaneous. The postoperative course was uneventful and she had no recurrence of CC after changing from the suspected drug (lansoprazole) to an H2-blocker. The characteristics of perforation by CC are characteristic longitudinal ulcer and micro-perforation. If it can be diagnosed accurately, conservative treatment may be an option. In spontaneous cases, the history of medication and the site of perforation may assist in this decision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CC:

Collagenous colitis

LPZ:

Lansoprazole

CS:

Colonoscopy

PPIs:

Proton pump inhibitors

References

  1. Freeman HJ. Collagenous inflammatory mucosal diseases of the gastrointestinal tract. Can J Gastroenterol. 1990;4:196–200.

    Article  Google Scholar 

  2. Okamoto R, Negi M, Tomii S, et al. Diagnosis and treatment of microscopic colitis. Clin J Gastroenterol. 2016;9:169–74.

    Article  PubMed  Google Scholar 

  3. Freeman HJ. Complications of collagenous colitis. World J Gastroenterol. 2008;14:1643–5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920–4.

    Article  CAS  PubMed  Google Scholar 

  5. Freeman HJ, Weinstein WM, Shnitka TK, et al. Watery diarrhea syndrome associated with a lesion of the colonic basement membrane-lamina propria interface. Ann R Coll Phys Surg Can. 1976;9:45.

    Google Scholar 

  6. Lindstrom CG. Collagenous colitis with watery diarrhea—a new entity? Pathol Eur. 1976;11:87–9.

    CAS  PubMed  Google Scholar 

  7. Beaugerie L, Pardi DS. Review article: drug-induced microscopic colitis—proposal for a scoring system and review of the literature. Aliment Pharmacol Ther. 2005;22:277–84.

    Article  CAS  PubMed  Google Scholar 

  8. Fernández-Bañares F, Esteve M, Espinós JC, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroenterol. 2007;102:324–30.

    Article  PubMed  Google Scholar 

  9. Sawada K, Fujiya M, Itabashi K, et al. Collagenous colitis appeared after 6-year administration of lansoprazole. Clin J Gastroenterol. 2010;3:18–21.

    Article  PubMed  Google Scholar 

  10. Freeman HJ. Long-term natural history and complications of collagenous colitis. Can J Gastroenterol. 2012;26:627–30.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mellander MR, Ekbom A, Hultcrantz R, et al. Microscopic colitis: a descriptive clinical cohort study of 795 patients with collagenous and lymphocytic colitis. Scand J Gastroenterol. 2016;51:556–62.

    Article  PubMed  Google Scholar 

  12. Fedor I, Zold E, Barta Z. Microscopic colitis: controversies in clinical symptoms and autoimmune comorbidities. Ann Med. 2021;53:1279–84.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Münch A, Tysk C, Bohr J, et al. Smoking status influences clinical outcome in collagenous colitis. J Crohns Colitis. 2016;10:449–54.

    Article  PubMed  Google Scholar 

  14. Fernandez-Bañares F, Esteve M, Salas A, et al. Bile acid malabsorption in microscopic colitis and in previously unexplained functional chronic diarrhea. Dig Dis Sci. 2001;46:2231–8.

    Article  PubMed  Google Scholar 

  15. Roth B, Gustafsson RJ, Ohlsson B. Auto-antibodies and their association with clinical findings in women diagnosed with microscopic colitis. PLoS ONE. 2013;8: e66088.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bürgel N, Bojarski C, Mankertz J, et al. Mechanisms of diarrhea in collagenous colitis. Gastroenterology. 2002;123:433–43.

    Article  PubMed  Google Scholar 

  17. Leigh C, Elahmady A, Mitros FA, et al. Collagenous colitis associated with chronic constipation. Am J Surg Pathol. 1993;17:81–4.

    Article  CAS  PubMed  Google Scholar 

  18. Bonderup OK, Hansen JB, Birket-Smith L, et al. Budesonide treatment of collagenous colitis: a randomised, double blind, placebo controlled trial with morphometric analysis. Gut. 2003;52:248–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Allende DS, Taylor SL, Bronner MP. Colonic perforation as a complication of collagenous colitis in a series of 12 patients. Am J Gastroenterol. 2008;103:2598–604.

    Article  PubMed  Google Scholar 

  20. Freeman HJ, James D, Mahoney CJ. Spontaneous peritonitis from perforation of the colon in collagenous colitis. Can J Gastroenterol. 2001;15:265–7.

    Article  CAS  PubMed  Google Scholar 

  21. Bohr J, Larsson LG, Eriksson S, et al. Colonic perforation in collagenous colitis: an unusual complication. Eur J Gastroenterol Hepatol. 2005;17:121–4.

    Article  PubMed  Google Scholar 

  22. Bennett M, Tompkins H, Seymour B, et al. Spontaneous colonic perforation in a patient with collagenous colitis. Gastroenterol Hepatol. 2013;9:262–4.

    Google Scholar 

  23. Akamoto S, Fujiwara M, Okano K, et al. Spontaneous perforation in collagenous colitis. Surgery. 2014;155:198–9.

    Article  PubMed  Google Scholar 

  24. Cottreau J, Kelly R, Topp T, et al. Spontaneous colonic perforation: a rare complication of collagenous colitis. Clin J Gastroenterol. 2016;9:140–4.

    Article  PubMed  Google Scholar 

  25. Mitchell A, Dugas A. Collagenous colitis presenting as spontaneous perforation in an 80 year old woman: report of a Case. BMC Gastroenterol. 2016;16:124.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mori H, Miyake T, Shimizu T, et al. A case of spontaneous colonic perforation in collagenous colitis. Surg Case Rep. 2019;5:90.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Umeno J, Matsumoto T, Nakamura S, et al. Linear mucosal defect may be characteristic of lansoprazole-associated collagenous colitis. Gastrointest Endosc. 2008;67:1185–91.

    Article  PubMed  Google Scholar 

  28. Cruz-Correa M, Milligan F, Giardiello FM, et al. Collagenous colitis with mucosal tears on endoscopic insufflation: a unique presentation. Gut. 2002;51:600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Van Eijk RL, Bac DJ. Mucosal tears and colonic perforation in a patient with collagenous colitis. Endoscopy. 2014;46:E64.

    Article  PubMed  Google Scholar 

  30. Koulaouzidis A, Yunga DE, Nemethb A, et al. Macroscopic findings in collagenous colitis: a multi-center, retrospective, observational cohort study. Ann Gastroenterol. 2017;30:309–14.

    PubMed  PubMed Central  Google Scholar 

  31. Hussain Z, Kelly S, Clarke A, et al. Colonic perforation in collagenous colitis: a systematic review of a rare complication and guidance on management. Surg Endosc. 2010;24:2930–4.

    Article  CAS  PubMed  Google Scholar 

  32. Tanaka M, Mazzoleni G, Riddell RH. Distribution of collagenous colitis: utility if flexible sigmoidoscopy. Gut. 1992;33:65–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Sherman A, Ackert JJ, Rajapaksa R, et al. Fractured colon: an endoscopically distinctive lesion associated with colonic perforation following colonoscopy in patients with collagenous colitis. J Clin Gastroenterol. 2004;38:341–5.

    Article  PubMed  Google Scholar 

  34. Ueda T, Tanaka T, Yokoyama T, et al. Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report. Surg Case Rep. 2020;6:3.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors declare that this study was not funded externally.

Author information

Authors and Affiliations

  1. Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan

    Tomomi Sadamitsu, Takeshi Ueda, Tetsuya Tanaka, Takashi Yokoyama & Atsushi Yoshimura

  2. Kawakami Village National Health Insurance Kawakami Clinic, 1334-23 Sako, Kawakami-mura, Yoshino-gun, 639-3553, Japan

    Eitetsu Boku

Authors
  1. Tomomi Sadamitsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eitetsu Boku
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuya Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsushi Yoshimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TS and TU contributed to the study conception and design, data collection, and analysis and interpretation of data. EB contributed to the data collection and interpretation of data. TT and TY were involved in the decision to publish or the preparation of the manuscript. AY contributed to the study supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takeshi Ueda.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the patient for the publication of this case report and any accompanying images.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadamitsu, T., Ueda, T., Boku, E. et al. Spontaneous colonic perforation with collagenous colitis in an elderly patient. Clin J Gastroenterol 15, 1083–1087 (2022). https://doi.org/10.1007/s12328-022-01707-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-022-01707-4

Keywords

Search

Navigation