Florida State University, Sarasota Memorial Hospital Sarasota, FL, United States
Mindy Ward, DO1, Katherine Burns, DO2, Ian Nora, MD2, Wilhelmine Wiese-Rometsch, MD2, Charles J. Loewe, MD3 1Florida State University, Sarasota Memorial Hospital, Sarasota, FL; 2Florida State University, Sarasota, FL; 3Sarasota Center for Digestive Diseases, Sarasota, FL
Introduction: Colitis cystica profunda (CCP) is often seen in inflammatory environments and always warrants investigation of the underlying condition. Few cases have been reported in the setting of diverticulitis. Typical symptoms of CCP include mucorrhea, rectorrhagia, or hematochezia.
Case Description/Methods: A 60-year-old man presented to the ED with abdominal pain, nausea, and poor oral intake. He reported abdominal pain for several months with worsening pain, anorexia, nausea without vomiting, and decreased flatus in the preceding week. He described “pencil-thin” stools and denied a family history of colon cancer. Pertinent physical exam included stable vital signs in a cachectic and chronically ill-appearing male. Abdominal exam revealed distention and a palpable deformity of the left lower quadrant; digital rectal exam demonstrated a palpable rectal mass.
Contrast CT of the abdomen/pelvis showed a focal stricture of the proximal sigmoid colon consistent with a high-grade obstruction concerning for neoplasm. Flexible sigmoidoscopy revealed multiple diverticula. Colonoscopy completed an evaluation of the colon, showing a 10 mm sessile polyp in the rectum.
Symptoms worsened with the inability to pass stool requiring nasogastric decompression. Exploratory laparotomy demonstrated stricture of the rectosigmoid and diverticular disease, for which he underwent rectosigmoid dissection. Postoperatively the patient recovered without additional symptomatology. Pathology revealed CCP.
Discussion: CCP is a benign entity, seen in association with multiple settings such as inflammatory bowel disease (IBD), cancer, or trauma. It oftentimes can be managed with inflammatory symptom control. CCP often affects younger patients (20 – 40 years old) with no clear gender preference. Literature review yielded less than 100 cases. Specific examples of reported underlying conditions include strictures secondary to uncontrolled IBD; post-appendectomy, pelvic radiation, and self-inflicted anal manipulation. Two cases were reported with diverticular disease as seen in our patient.
We present a case of CCP in the setting of diverticular disease that could have easily been misdiagnosed as adenocarcinoma. The large variety of associated pathologies seen with CCP highlights the need to search for associated conditions as CCP rarely exists alone. This case also reinforces the need for histological confirmation of image findings that may be suspicious of malignancy.
Figure: colitis cystica profunda polyp in the rectum
Disclosures: Mindy Ward indicated no relevant financial relationships. Katherine Burns indicated no relevant financial relationships. Ian Nora indicated no relevant financial relationships. Wilhelmine Wiese-Rometsch indicated no relevant financial relationships. Charles Loewe indicated no relevant financial relationships.
Mindy Ward, DO1, Katherine Burns, DO2, Ian Nora, MD2, Wilhelmine Wiese-Rometsch, MD2, Charles J. Loewe, MD3. P1280 - Colitis Cystica Profunda: A Great Pretender, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.