Intestinal obstruction and abdominal compartment syndrome secondary to colitis cystica profunda: Case report and review of the literature

Abstract

Colitis cystica profunda is a rare pathology with approximately 200 cases reported in the literature. This entity is characterized by a slow, asymptomatic evolution and when finally recognized, confusion with a malignant tumor with subsequent application of unnecessary therapies or surgical resections is frequent. We present the case of a 41-year-old male with 7-day evolution ultimately presenting to the emergency room with abdominal pain. At physical examination, he was dehydrated with severe abdominal pain, tachycardia and tachypnea, abdominal distention, without bowel sounds, wood with clearly acute abdomen signs, and anuria for 48 h. The patient required mechanical ventilation secondary to abdominal restriction with severe metabolic acidosis. The situation of hemoglobin (14.5 mg/dL), hematocrit (38), leukocytes (18,500/mm [3] with 89% neutrophils), platelets (257,000), creatinine (2.1 mg/dL), glucose (230 mg/dL), and normal clotting times were included in the laboratory reports. The diagnosis was intestinal obstruction, abdominal compartment syndrome, and septic and hypovolemic shock. At exploratory laparotomy, we found a sigmoidal tumor totally occluding the lumen with severe dilatation of the proximal colon and haustral tearing with ischemia. Totally, 2 m of ileum showed necrotic patches secondary to compartment syndrome and compression to the abdominal wall. A total colectomy and resection of 2 m of ileum with ileostomy and Hartmann's procedure were completed. The pathology examination reported colitis cystica profunda without atypia. After 3 weeks and stoma remodelation, the patient was discharged. This benign lesion could be treated with less aggressive procedures. With the correct pathological diagnosis, a better treatment with excellent prognosis could have resulted.