“Cat scratch colon” is an endoscopic finding characterised by the presence of bright red, linear markings in the colonic mucosa which resemble scratches made by a cat. The appearance of these lesions has been attributed to barotrauma secondary to insufflation during colonoscopy.
Our case study is a 69-year old female patient, with no medical history of interest, who was referred to our unit to undergo a screening colonoscopy for colorectal carcinoma after a positive faecal occult blood test result. The colonoscopy procedure was performed after bowel preparation with polyethylene glycol, using propofol sedation and CO2 insufflation. Advancement of the endoscope was not traumatic, but, on passing the tube through the proximal transverse colon, ascending colon and caecum, various erythematous longitudinal lines were identified in the mucosa with spontaneous mucosal bleeding (Fig. 1). The rectum had multiple millimetric polyps which were removed. The rest of the colonic mucosa was macroscopically normal. The examination was performed without incident and no secondary complications were observed. Histopathology results revealed hyperplastic polyps and colonic mucosa with no histological alterations.
“Cat scratch colon” was first described by McDonnell et al. in 20071 and is defined as the presence of bright, erythematous linear breaks that tend to arise in the right colon and that may occasionally be accompanied by extravasations of fresh blood. These lesions generally have no clinical implications but cases of perforation, even after insufflation with CO2, have been described.2
Although its aetiology is unknown, some authors have suggested that its main pathogenic mechanism is barotrauma secondary to insufflation during colonoscopy. Nevertheless, an association with different pathological processes that may affect distensibility of the colon, such as collagenous colitis or diversion colitis, and prior administration of nonsteroidal anti-inflammatories has been described.3,4 More recently, a case study involving “cat scratch colon” in a patient with ischaemic colitis has been published. In this case study, the authors suggest that increased stiffness of the colon walls secondary to ischaemia may play a role in the appearance of mucosal breaks due to increased pressure as a result of air insufflation during colonoscopy.5 In our case study, the colonic mucosa was macroscopically normal and the biopsies taken also ruled out the presence of collagenous colitis.
“Cat scratch colon” is a rare endoscopic finding that normally has no clinical implications and tends to occur as a result of barotrauma secondary to insufflation or other processes affecting distensibility of the colon.
Please cite this article as: Mora Cuadrado N, Alcaide Suárez N, Antolín Melero B, Burgueño Gómez B, Durà Gil M, Fernández Salazar LI, et al. Hallazgo inesperado de colon en arañazo de gato en una colonoscopia de cribado. Gastroenterol Hepatol. 2019;42:172–173.
