Colitis cystica profunda.

Abstract

Colitis cystica profunda has been infrequently reported in the literature. Although it is not malignant, on x-ray examination it can easily be confused with a neoplasm (1). Its etiology has been attributed to several conditions, such as chronic irritation and congenital weakness of the musculature, but has not been established and remains a pathological enigma. In previously reported cases, the lesion has usually been in the rectum or sigmoid and relatively small, from 1.0 to 4.0 or 5.0 cm in diameter, and because of its size it has not generally required surgery. In the case reported below, however, the lesion was very bulky and extended from the mid-transverse colon to the lower descending colon. Because it bordered on complete obstruction, radical surgery was required. This afforded an excellent gross study. Case Report D. L. M., a 36-year-old white male, was first admitted in 1964 with complaints of diarrhea and occasional passage of bloody stools. The roentgenograms at that time were essentially normal, but a few minor defects of superficial ulceration were noted (Fig. 1). Stool studies for ova and parasites were negative. A diagnosis was made of ulcerative colitis, for which the patient was treated medically. The symptoms were controlled with steroids and diet until the present illness, which was insidious in the six to eight months before the present admission. Stools were frequent, often containing free blood. There was a gradual loss of weight which, with the diarrhea, made it difficult for the patient to carry on with his rather strenuous job. A roentgenogram from an outpatient barium-enema examination in September 1966 is shown in Figure 2. Because of the x-ray findings a bland diet with low residue was prescribed, together with intestinal antibiotics. Three weeks later the patient was admitted to the hospital, and the barium-enema study was repeated (Figs. 3–4). On Oct. 21, the patient underwent surgery. Prior to operation the hematocrit was 34, the hemoglobin 11.7 g per 100 cc, and the urinalysis normal. The exploratory laparotomy ended as a transverse colectomy and a double colostomy. The operative record read in part: “Satisfactory identification of a tumor could not be made extraluminally. A colotomy performed in the mid portion of the transverse colon disclosed a large number of villous polypoid structures obstructing the bowel by the mere mass of their presence. Several biopsies submitted to the pathologist were reported as showing inflammation with no definite evidence of neoplasm. A segment of transverse colon approximately 20 cm in length was resected…” The pathologist reported that, grossly, an abundant, apparently normal omentum was attached to the colon. Numerous finger-like villi within the colon measured up to 3.5 cm in length and up to approximately 0.5 cm in diameter, averaging between 0.2 and 0.3 cm in diameter. Many were anastomosed, forming a complex network.