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Ischemic colitis or melanosis coli: a case report

Chaudhary BN, Sharma H, Nadeem M, Niayesh MH - World J Emerg Surg (2007)

Bottom Line: Its a benign condition, which arises from anthraquinone laxative abuse and has no symptoms of its own.We present a case of extensive Melanosis Coli involving the whole of large bowel that appeared gangrenous.A sub total colectomy was performed on presumed diagnosis of ischemic bowel.

Affiliation: Department of General Surgery, Frenchay Hospital, Bristol, UK. babernaseer@yahoo.com.

ABSTRACT

Background: Melanosis Coli is described as black or brown discolouration of the mucosa of the colon. Its a benign condition, which arises from anthraquinone laxative abuse and has no symptoms of its own. The main importance of diagnosing Melanosis Coli correctly lies in the fact that if its extensive, there may be difficulty in differentiating it from ischemic colitis.

Case presentation: We present a case of extensive Melanosis Coli involving the whole of large bowel that appeared gangrenous. A sub total colectomy was performed on presumed diagnosis of ischemic bowel.

Conclusion: This report reminds the clinicians that extensive Melanosis Coli may mimic ischemic colitis and thus must be considered as a differential diagnosis.

Melanosis Coli in a pericolonic lymph node.
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Figure 2: Melanosis Coli in a pericolonic lymph node.

Mentions: A 63 years old woman presented with a two days history of worsening abdominal pain and distention. She had a past history of deep venous thrombosis, atrial fibrillation [AF] and long standing constipation. Her medications included various herbal laxatives and warfarin. On examination she had quite a distended abdomen with diffuse abdominal tenderness. The blood investigations showed an abnormal white cell count of 14 × 103/dland a CRP of 40. An abdominal CT scan revealed a marked gaseous distention of large bowel with no evidence of stricture or mass lesion. The patient underwent an emergency operation. On laparotomy the large bowel was quite distended and looked akinetic. The mucosa appeared dusky and necrotic from the outside. This abnormal appearance started from caecum and involved the large bowel all the way to the rectosigmoid junction. The pulses, however, were present in the major vessels and the serosa looked moist. There was no obstructing lesion distally and the small bowel was normal. The macroscopic appearance of dusky large bowel mucosa taken together with a history of AF led us to the diagnosis of ischemic colitis. A sub-total colectomy was performed with an end ileostomy. (Figure 1) Patient recovered uneventfully from her operation and was discharged on 6th postoperative day. The histopathology revealed extensive Melanosis Coli with spread to the pericolonic lymph nodes. (Figure 2) There was no evidence of bowel ischemia.

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Ischemic colitis or melanosis coli: a case report

Chaudhary BN, Sharma H, Nadeem M, Niayesh MH - World J Emerg Surg (2007)

Melanosis Coli in a pericolonic lymph node.
© Copyright Policy - open-access
Figure 2: Melanosis Coli in a pericolonic lymph node.
Mentions: A 63 years old woman presented with a two days history of worsening abdominal pain and distention. She had a past history of deep venous thrombosis, atrial fibrillation [AF] and long standing constipation. Her medications included various herbal laxatives and warfarin. On examination she had quite a distended abdomen with diffuse abdominal tenderness. The blood investigations showed an abnormal white cell count of 14 × 103/dland a CRP of 40. An abdominal CT scan revealed a marked gaseous distention of large bowel with no evidence of stricture or mass lesion. The patient underwent an emergency operation. On laparotomy the large bowel was quite distended and looked akinetic. The mucosa appeared dusky and necrotic from the outside. This abnormal appearance started from caecum and involved the large bowel all the way to the rectosigmoid junction. The pulses, however, were present in the major vessels and the serosa looked moist. There was no obstructing lesion distally and the small bowel was normal. The macroscopic appearance of dusky large bowel mucosa taken together with a history of AF led us to the diagnosis of ischemic colitis. A sub-total colectomy was performed with an end ileostomy. (Figure 1) Patient recovered uneventfully from her operation and was discharged on 6th postoperative day. The histopathology revealed extensive Melanosis Coli with spread to the pericolonic lymph nodes. (Figure 2) There was no evidence of bowel ischemia.

Bottom Line: Its a benign condition, which arises from anthraquinone laxative abuse and has no symptoms of its own.We present a case of extensive Melanosis Coli involving the whole of large bowel that appeared gangrenous.A sub total colectomy was performed on presumed diagnosis of ischemic bowel.

Affiliation: Department of General Surgery, Frenchay Hospital, Bristol, UK. babernaseer@yahoo.com.

ABSTRACT

Background: Melanosis Coli is described as black or brown discolouration of the mucosa of the colon. Its a benign condition, which arises from anthraquinone laxative abuse and has no symptoms of its own. The main importance of diagnosing Melanosis Coli correctly lies in the fact that if its extensive, there may be difficulty in differentiating it from ischemic colitis.

Case presentation: We present a case of extensive Melanosis Coli involving the whole of large bowel that appeared gangrenous. A sub total colectomy was performed on presumed diagnosis of ischemic bowel.

Conclusion: This report reminds the clinicians that extensive Melanosis Coli may mimic ischemic colitis and thus must be considered as a differential diagnosis.

View Similar Images In: Results  - Collection
View Article: PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2077330&rFormat=json&query=null&req=5