Benign Ulcer of the Sigmoid Colon

Abstract

Simple benign ulceration of the colon is an unusual condition that may simulate carcinoma clinically and radiologically, and complications usually develop before it is recognized clinically (3, 7, 12, 14, 15). Since the initial description by Cruveilhier (8) in 1835, 105 cases have been reported. 52 of them since 1928 (9, 12). Of this latter group, only 8 or 15 per cent were in the sigmoid. No specific etiology of the disease has been found, although it has been reported in systemic disease (13) and in a patient treated with a drug having known ulcerogenic properties (9). A report of this entity seems indicated so that radiologists will be aware of it, may differentiate it from malignant lesions, and may consider it in patients being treated with known ulcerogenic drugs. Case Report M. C., a 70-year-old white male, was admitted to the Yale-New Haven Hospital on Aug. 27, 1966, with severe rectal bleeding. The patient had suffered from severe arthritis of long duration, for which phenylbutazone, six tablets daily, had been given for nine years. Since the beginning of phenylbutazone therapy, the patient had noted several loose bowel movements per day. On two previous occasions during the year prior to his most recent admission, he had been hospitalized for acute rectal bleeding. On these previous admissions, a barium enema examination was unrevealing, and rectal bleeding ceased when phenylbutazone therapy was discontinued. Acute flare-ups of arthritis necessitated the re-institution of phenylbutazone therapy, which resulted in severe rectal bleeding each time. A barium enema examination on the final admission showed a conical narrowing of the sigmoid colon with evidence of ulceration. Minimal changes in the contour of the lesion could be demonstrated (Figs. 1 and 2). These findings were in favor of a benign process; a shelf-like margin at both ends of the lesion, however, suggested tumor. The preoperative diagnosis was a stenosing lesion of the sigmoid, probably benign, but carcinoma could not be excluded. Operation disclosed induration of the sigmoid and proximal descending colon. The induration was most severe in the sigmoid, and this was resected. Grossly, it contained two large 2 × 3 cm ulcers with sharply demarcated edges. Microscopically, the base consisted of granulation tissue with a dense chronic inflammatory infiltrate. No reaction was seen in the adjacent mucosa. Infectious and malignant diseases were excluded. Discussion The majority of reported benign ulcers of the colon of nonspecific etiology occur in the cecum and ascending colon (3, 12). Approximately 15 per cent have been encountered in the sigmoid colon. The diagnosis is usually heralded by an abdominal catastrophe with perforation, abscess formation, and peritonitis. Constipation has been an almost universal complaint. Definite preoperative diagnosis could be made in only one case (4).