1885 Cat Scratch Stomach: A Rare Endoscopic Finding

Abstract

INTRODUCTION: “Cat scratch colon” has been used in literature to describe superficial linear hemorrhagic tears in the colon that resemble scratches from a cat’s claws. These tears are rare, with a prevalence of about 0.25% and are usually found in the right colon and cecum in association with barotrauma during colonoscopy. Cases reporting these findings were associated with less compliant colons, as in collagenous colitis, diversion colitis, and colonic compression. Cat scratch findings in the stomach have been less common. Here we report the case of a young female with “cat scratch” findings in the stomach during upper endoscopy. CASE DESCRIPTION/METHODS: A 29-year-old female with autoimmune thyroiditis and ileocolonic Crohn’s disease presented to our clinic endorsing a 30-pound weight loss over 3 years, abdominal pain, sitophobia, nausea, and overlapping symptoms of diarrhea and constipation. She endorsed occasional ketorolac use for her menstrual symptoms. She denied vomiting, hematochezia, melena, past or current substance use, laxative use, or eating disorder. Abdomen was nontender on exam. Endoscopy initially revealed normal esophagogastroduodenal mucosa, but as the endoscope was withdrawn, several “cat scratch” lacerations were noted in the gastric fundus and cardia. Equipment was confirmed to be supplying CO2. Antral and duodenal biopsies revealed chronic gastritis and focal metaplasia, but were negative for Helicobacter pylori. Colonoscopy and colonic biopsies were normal. DISCUSSION: In the only other reported case of “cat scratch stomach” in a 47-year-old male with dyspepsia and otherwise unremarkable history, the authors hypothesized that air retention from the pylorus and lower esophageal sphincter led to colonic over-distention and contributed to the tears. Similarly, our findings may be sequelae of barotrauma despite sole use of CO2. Considering the patient’s nonsteroidal anti-inflammatory drug (NSAID) use and the correlation of “cat scratch colon” with collagenous colitis, collagenous gastritis may also predispose these findings, despite absence on our biopsy. The significance of these endoscopic findings is not yet clear. As such, we hope to add to the literature to help elucidate the etiology and clinical significance of these gastric tears.