Solitary cecal ulcer: A case report and literature review

Shah, Shamik; Sangwan, Pravesh; Wongkar, Meta; Patel, Nishith; Bajwa, Qasim; Mehta, Priya; Moroianu, Andrew; Heller, Debra A.; Sabatino, John; Kaswala, Dharmesh; Brelvi, Zamir

doi:10.4103/2348-3113.133533

Cited by 4 publications

(14 citation statements)

References 9 publications

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“…A similar case has been reported by Kela et al ,12 where ileal tuberculosis has presented with massive rectal bleeding without any evidence of active pulmonary tuberculosis. A case of solitary caecal ulcer has been reported by Shah et al 13 in the literature, which was managed conservatively as the patient refused surgery, but in our case, there was life-threatening LGIB which necessitated an emergency surgery.

Learning points

Non-specific caecal ulcer as a cause of lower gastrointestinal haemorrhage is to be forgotten and an earnest attempt should be made towards identifying a specific aetiology.

Segmental colonic resection is useful for emergency control of bleeding.

Histopathological examination is the gold standard, supplemented by modern investigations.

…”

Section: Discussionmentioning

confidence: 61%

Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge

et al. 2014

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Gastrointestinal (GI) haemorrhage is a common surgical emergency accounting for approximately 1% of acute hospital admissions. Lower GI bleed is less common and less severe than upper GI bleed and is usually caused by diverticulosis, neoplasms, angiodysplasia and inflammatory bowel disease. A 51-year-old man presented with massive lower GI bleed. He had no history of tuberculosis. He underwent colonoscopy and an isolated caecal ulcer was noted. Segmental ileocaecal resection was performed and no specific cause was identifiable on histopathology. PCR was performed on this specimen and it was positive for Mycobacterium tuberculosis. This case reports the unusual presentation of tuberculosis as solitary caecal ulcer with massive lower GI bleed and highlights the role of PCR as an adjuvant diagnostic tool for its diagnosis when characteristic histopathological findings are absent.

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Learning points

Non-specific caecal ulcer as a cause of lower gastrointestinal haemorrhage is to be forgotten and an earnest attempt should be made towards identifying a specific aetiology.

Segmental colonic resection is useful for emergency control of bleeding.

Histopathological examination is the gold standard, supplemented by modern investigations.

…”

Section: Discussionmentioning

confidence: 61%

Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge

et al. 2014

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“…However, their review did not separate patients who underwent colonoscopy due to anaemia or blood loss, which suggests this finding is even less frequent than reported. The differential diagnosis for a solitary proximal colon ulcer includes malignancy, IBD, medication side effect, chemical injury and infection 5 11. In addition to CMV, other infectious causes of colonic ulceration include amoebiasis and tuberculosis 10.…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis for solitary ulceration within the proximal colon on colonoscopy includes malignancy, inflammatory bowel disease (IBD), medication side effect, chemical injury and infection 5. Among medications, non-steroidal anti-inflammatory drugs are directly implicated in colonic ulceration 5 8 9. Infectious aetiologies include CMV infection, amoebiasis and tuberculosis 10…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Gastrointestinal (GI) cytomegalovirus (CMV) disease is an erosive process that can occur at any location in the GI tract and most often occurs in severely immunosuppressed patient groups such as those with acquired AIDS and transplant recipients 3 4. CMV disease affecting the lower GI tract has a wide clinical spectrum, but typically presents with acute or chronic diarrhoea and lower GI bleeding 5. Colonoscopy findings are also variable and include normal mucosa, haemorrhagic erythema and colitis that is often severe and widespread 3.…”

Section: Introductionmentioning

confidence: 99%

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Solitary ascending colon ulcer diagnosed as gastrointestinal CMV disease

Case

Stoner

Myrick³

2019

BMJ Case Rep

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A 42-year-old woman with a history of cholangiocarcinoma on adjuvant chemotherapy with capecitabine presented with painless haematochezia. She was found to have an isolated twenty-five mm ulcer in the ascending colon. Biopsies of the ulceration demonstrated typical cytomegalovirus (CMV) inclusions and her peripheral blood CMV PCR was significantly elevated. This is an unusual case of a solitary proximal colon ulcer. Non-steroidal anti-inflammatory drugs, inflammatory bowel disease and malignancy, are the most frequent causes of isolated ulcers in the proximal colon. Gastrointestinal (GI) CMV disease most commonly causes CMV colitis and is considered rare outside of the transplant population and other severely immunosuppressed patient groups. Patients who have received chemotherapy may also be at risk for GI CMV disease. The diagnosis should be suspected in patients who present with haematochezia or watery diarrhoea within a broad window of time after receiving chemotherapy.

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“…The most common symptom is abdominal pain in the lower-right quadrant but other symptoms include: melena or hematochezia, constipation, diarrhea and weight loss [1], [2], [3]. Preoperative and intraoperative diagnoses are hard to make and the definitive diagnosis is generally obtained by histology, with the surgical piece and/or a colonoscopic biopsy [5].…”

Section: Discussionmentioning

confidence: 99%

Solitary ulcer in cecum, mimicking a carcinoma: A case report

González-Urquijo

Rojas-Méndez

Tijerina-Gómez

2017

Annals of Medicine &Amp; Surgery

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IntroductionSolitary ulcers in the colon are rare and infrequent; little over 200 cases have been reported in medical literature. We present a case of a patient presenting with a solitary colonic ulcer associated with NSAIDs intake, mimicking a malignant lesion. A review of the literature is also revised.Presentation of case68- year-old female patient with past history of nonsteroidal anti-inflammatory drugs (NSAID) intake for chronic pain, complaining of severe abdominal pain was admitted to our teaching hospital. The diagnosis of a low-grade dysplasia was made with colonoscopy and biopsy, a malignant lesion could not be ruled out. A laparoscopy right colectomy was performed without complications. The final diagnosis resulted in a solitary cecal ulcer.DiscussionThe majority of the cases of solitary colonic ulcers occur in the ascending colon, at the cecum, which has been attributed mostly to the intake of NSAIDs. There could be solitary colonic ulcers in other portions of the large intestine, caused by different etiologies: ischemia, inflammatory disease, sterocoraceus ulcers, ulcers caused by infections, among other more uncommon causes. The diagnosis is often made through a biopsy of the tissue during a colonoscopy, with either surgical or conservative care.ConclusionThe diagnosis of solitary cecal ulcer should be considered in patients presenting with RLQ abdominal pain and with history of NSAIDs consumption. Recognition of this diagnosis by surgeons, ruling out malignancies, understanding the morphologic features, and carefully taking the patient's history are essential for the diagnosis and treatment of this uncommon disease.

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Solitary cecal ulcer: A case report and literature review

Cited by 4 publications

References 9 publications

Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge

Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge

Solitary ascending colon ulcer diagnosed as gastrointestinal CMV disease

Solitary ulcer in cecum, mimicking a carcinoma: A case report

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