Barotrauma in Collagenous Colitis

Abstract

Purpose: A 65 year-old female presented with a three months history of watery, non-bloody diarrhea which started after treatment for Helicobacter Pylori gastritis with antibiotics and Lansoprazole. Stool studies were negative. On diagnostic colonoscopy the left colon appeared normal. Bluish submucosal streaks with mucosal tears were seen in the right colon, with a small amount of blood in the cecum (Figure 1). Post-procedure the patient complained of severe abdominal pain and a plain X-ray revealed free air (Figure 2). During surgery, extensive pneumatosis was noted in the right colonic wall and mesenteric root. The site of the perforation could not be identified intraoperatively or on the resected specimen. A right hemicolectomy was performed. Histological examination revealed severe collagenous colitis. Patient is now doing well off Lansoprazole and on Mesalamine. Spontaneous and iatrogenic colonic perforations were previously reported in patients with collagenous colitis. Perforation is predominantly right-sided and correlates with severity of disease. If microscopic colitis is suspected, one should avoid excessive insufflation, consider use of CO2, or perform a limited left-sided examination. Submucosal blue streaks and linear ulcerations suggest barotrauma and may portend perforation. If these lesions are identified one should consider aborting the procedure and decompress the colon maximally on withdrawal.FigureFigure