PNEUMATOSIS COLI-A RARE MANIFESTATION OF SEVERE ULCERATIVE COLITIS HERALDING IMPENDING PERFORATION WITHOUT ACUTE ABDOMEN IN AN IMMUNOSUPPRESSED PATIENT

Abstract

Intramural colonic air, also known as pneumatosis coli, represents a manifestation of severe ulcerative colitis and often heralds impending perforation within areas of colonic necrosis. We present a case of an 18 year old female with severe UC who developed pneumatosis coli requiring emergent colectomy. An 18 year old female previously diagnosed with factor V leiden coagulopathy and mild proctitis presented with profuse bloody diarrhea and abdominal pain. Colonoscopy revealed severe pancolitis with backwash ileitis. Surveillance colonoscopy revealed no dysplasia. The patient was started on high dose corticosteroids and mesalamine 4.8g/d. 3 days later her baseline lower abdominal pain worsened slightly and the patient developed a low grade fever. CT scan demonstrated cecal pneumatosis coli. Emergent colectomy was performed. Subtotal colectomy and ileostomy were performed. Pathologic evaluation revealed severe ulceration, crypt abscesses, cryptitis, pseudopolyp formation with inflammation extending into the submucosa and the muscularis propria. The wall was not yet perforated. Pneumatosis coli represents a severe complication of ulcerative colitis. This rare condition can occasionally present without an acute abdomen, especially in immunosuppressed patients (e.g. steroid therapy). Pneumatosis coli represents air, often from gas forming bacteria, within the colonic wall and heralds impending perforation and bowel wall necrosis. A high index of suspicion for toxicity should prompt early evaluation and intervention to avoid poor outcome (e.g. perforation, sepsis, toxic megacolon). [figure 1][figure 2]FigureFigure