1/10. Colonic perforation in collagenous colitis: an unusual complication. Collagenous colitis is generally regarded as a benign disease with few serious complications. We report two women with collagenous colitis who presented with colonic perforation, one spontaneously and one 7 days after a barium enema, and a review of the literature. Including the present cases, 13 patients with collagenous colitis and colonic perforation have been reported, in two patients spontaneously and in 11 patients after a colonoscopy or barium enema. All were operated on except one patient who recovered after medical treatment. The pathogenesis of this complication is unknown. We propose that there might be a connection between mucosal tears and colonic perforation in collagenous colitis. ( info) |
2/10. Primary AL-amyloidosis, ulcerative colitis and collagenous colitis in a 57-year-old woman: a case study. A 57-year-old woman with AL-amyloid deposits in the heart, gastrointestinal tract and the liver developed ulcerative colitis, which was treated with glucocorticosteroids and 5-aminosalicylic acid, with good response. The AL-amyloidosis was successfully treated with high-dose chemotherapy and autologous stem-cell transplantation. The patient was in good clinical condition for 18 months after treatment, until she developed diarrhea, which was found to be due to collagenous colitis. Two years after treatment of amyloidosis, the patient is in excellent condition, the symptoms of heart failure have stabilized and no adverse effects of the treatment regime have been observed. The bowel diseases are in clinical remission. ( info) |
3/10. Progression of collagenous colitis to Crohn's disease. Collagenous colitis is a condition usually characterized by watery diarrhoea, macroscopically normal colonic mucosa and a typically thickened subepithelial collagen band on histological examination. It is rare in children, and coexistence with other inflammatory bowel diseases has been reported only rarely. We describe a case of diarrhoea presenting in infancy subsequently proved to be collagenous colitis that progressed to the typical features of Crohn's disease. ( info) |
4/10. Microscopic colitis: a report of two cases. Microscopic colitis is characterized by chronic, watery, secretory diarrhea, with a normal or near-normal gross appearance of the colonic mucosa. biopsy is diagnostic and usually reveals either lymphocytic colitis or collagenous colitis. The symptoms of collagenous colitis appear most commonly in the sixth decade. With collagenous colitis, the major microscopic characteristic is a thickened collagen layer beneath the colonic mucosa, and with lymphocytic colitis, an increase number of intraepithelial lymphocytes. Clinically, collagenous colitis is characterized by long-standing diarrhea. In patients with lymphocytic colitis, the duration of diarrhea is usually shorter and female predominance is less apparent. We report two cases of lymphocytic colitis in elderly women. Both presented with watery diarrhea of two month duration and weight loss. Extensive investigations were done and several medications failed to stop their diarrhea. biopsy revealed lymphocytic colitis. Their diarrhea responded well to cholestyramine. ( info) |
5/10. Collagenous colitis, ulcerative colitis, coeliac disease and hyperparathyroidism in one patient: implications for the management of collagenous colitis. A case of collagenous colitis, ulcerative colitis and coeliac disease all occurring in one individual is reported. In addition to causing confusion over symptoms, this observation coupled with a review of the literature raises the question of whether patients with collagenous colitis should be routinely screened for coeliac disease. Furthermore, the threshold for re-investigating for the possibility of the development of ulcerative colitis may have to be lowered, particularly if symptoms change. ( info) |
6/10. Resolution of paraneoplastic collagenous enterocolitis after resection of colon cancer. A 52-year-old woman developed severe watery diarrhea, weight loss, anemia and hypoalbuminemia. A localized colon cancer was detected. Subsequently, extensive collagenous mucosal involvement of the small and large intestine was discovered. After resection of the colon cancer, her symptoms resolved. In addition, resolution of the inflammatory process occurred, including the subepithelial collagen deposits. Despite extensive small and large intestinal involvement, both clinical and histological resolution of collagenous inflammatory disease was evident. Collagenous enterocolitis is an inflammatory process that may represent a distinctive and reversible paraneoplastic phenomenon. ( info) |
7/10. Colonic mucosal tears in collagenous colitis. In general, the colonic mucosa is macroscopically normal in collagenous colitis, although minor, non-specific abnormalities may be found. Significant endoscopic abnormalities, "mucosal tears" representing longitudinal mucosal lacerations, have been reported in a few patients with collagenous colitis. We report the cases of three women with collagenous colitis and mucosal tears detected at the index colonoscopy in order to illustrate the endoscopic characteristics and review the literature. Including the present cases, a total of 12 patients with mucosal tears and collagenous colitis have been reported. In 10 patients, the mucosal lacerations involved the ascending or the transverse colon. Three of the 12 patients had a colonic perforation immediately after the colonoscopy. The colonoscopist should be aware that the risk of perforation is likely to be increased when mucosal tears are present. ( info) |
8/10. Collagenous colitis: possible link with isotretinoin. A case of collagenous colitis in a young man treated by isotretinoin raises the hypothesis of an isotretinoin inducedcess on the oossible account of atoov and auto-immunity in the family. ( info) |
9/10. Collagenous pouchitis. Collagenous colitis is characterised by watery diarrhoea, normal colonic mucosa on endoscopy, diffuse colitis with surface epithelial injury, and a distinctive thickening of the subepithelial collagen table on histology. Some patients can develop medically refractory collagenous colitis, in which case they may require surgical intervention. This is the first report of collagenous pouchitis in a collagenous colitis patient with proctocolectomy and ileal pouch-anal anastomosis. A patient with medically refractory collagenous colitis who underwent a total proctocolectomy and ileal pouch-anal anastomosis was sequentially evaluated with an endoscopy and histology of the colon, distal small intestine, and ileal pouch. A 58-year-old female had a 10-year history of collagenous colitis before having a total proctocolectomy and ileal pouch-anal anastomosis for medically refractory disease. The histologic features of collagenous colitis were present in all colon and rectum biopsy or resection specimens, but were absent in the distal ileum specimen. The post-operative course was complicated by persistent increase of stool frequency, abdominal cramps, and incontinence. A pouch endoscopy was performed 3 years after ileal pouch-anal anastomosis which showed the histologic features of collagenous colitis in the ileal pouch, collagenous pouchitis, while the pre-pouch neo-terminal ileum had no pathologic changes. After antibiotic therapy, the histologic changes of collagenous pouchitis resolved. This is the first reported case of collagenous pouchitis. Since the abnormal collagen table and its associated features were only present in the pouch and absent in the neo-terminal ileum, and the patient had histologic improvement after antibiotic therapy, it would suggest that faecal stasis and bacterial load may play a role in the pathogenesis. ( info) |
10/10. A case of vulvar pyoderma gangrenosum associated with collagenous colitis. pyoderma gangrenosum is a reactive inflammatory dermatosis which belongs to the spectrum of neutrophilic dermatoses. Due to a lack of diagnostic criteria, pyoderma gangrenosum is mainly a diagnosis of exclusion. It is rarely observed on the perineum, and vulvar involvement is even less frequent. Collagenous colitis is an idiopathic inflammatory colonic disease that is included in the microscopic colitides. The colonic mucosa and the crypt architecture are preserved but histologic alterations are found. We describe a case of collagenous colitis associated with vulvar pyoderma gangrenosum that improved spectacularly with cyclosporine 3 mg/kg/day and the twice-daily application of topical tacrolimus 0.1%. ( info) |