Image of the month
Endoscopic image simulating a rectal neoplasm in a case of ischemic colitis
Imagen endoscópica simulando una neoplasia de recto en un caso de colitis isquémica
Antonio Garrido-Serrano
, María Belvis-Jiménez, Belén Maldonado-Pérez, Rafael Romero-Castro
Corresponding author
Servicio de Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, Spain
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The colonoscopy revealed inflammatory lesions ≥5 cm from the anal margin to the mid-sigmoid colon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with biopsies consistent with ischaemic colitis. An abdominal computed tomography (CT) scan showed involvement of the upper rectum and the sigmoid and descending colon. The patient followed a poor clinical course, so a new colonoscopy was performed two weeks later. The new colonoscopy showed that the lesions had progressed, with apparent neoplastic stenosis in the upper rectum; however, biopsies once again confirmed the ischaemic nature of the lesion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient underwent resection of the affected segments and transverse colostomy, and the study of the specimen confirmed the diagnosis of ischaemic colitis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Ischaemic colitis is the most common form of intestinal ischaemic lesion. The clinical picture ranges from mild and transient to fulminant. Lower rectum involvement is seen in 5% of cases,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> as in our patient.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Colonoscopy is the technique of choice, although complications as a result of reduced blood flow due to overdistension and increased intracolonic pressure have been reported.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A severe inflammatory response can cause the mucosa and submucosa to overlap and simulate a neoplasm, as in our case.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garrido-Serrano A, Belvis-Jiménez M, Maldonado-Pérez B, Romero-Castro R. Imagen endoscópica simulando una neoplasia de recto en un caso de colitis isquémica. Gastroenterol Hepatol. 2021;44:724–725.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 611 "Ancho" => 750 "Tamanyo" => 92824 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">First colonoscopy image: rectal and sigmoid mucosa with oedema, erythema, and wide and deep ulcerations with a fibrinopurulent base.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 623 "Ancho" => 750 "Tamanyo" => 57728 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Second colonoscopy image: expansive, bumpy, friable and stenosing lesion in the upper rectum.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 573224 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological study image: Panels A–C) Hyalinisation of the lamina propria, atrophic crypts and a severe inflammatory component. Panel D) Extensive areas of bleeding are also observed, all consistent with ischaemic colitis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on ischemic colitis: from etiopathology to treatment including patients of intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Doulberis" 1 => "P. Panagopoulos" 2 => "S. Scherz" 3 => "E. Dellaporta" 4 => "G. Koukakis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/00365521.2016.1162325" "Revista" => array:6 [ "tituloSerie" => "Scand J Gastroenterol." "fecha" => "2016" "volumen" => "51" "paginaInicial" => "893" "paginaFinal" => "902" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27152750" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischemic colitis following uncomplicated colonoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.T. Jendrek" 1 => "K.J. Schmidt" 2 => "K. Fellerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0041-107543" "Revista" => array:6 [ "tituloSerie" => "Z Gastroenterol." 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"fecha" => "1995" "volumen" => "68" "paginaInicial" => "1538" "paginaFinal" => "1541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1893354" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004400000010/v1_202112030713/S244438242100211X/v1_202112030713/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004400000010/v1_202112030713/S244438242100211X/v1_202112030713/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244438242100211X?idApp=UINPBA00004N" ]
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