"Cat scratch colon" in a patient with ischemic colitis

"Cat scratch colon" causing cecal perforation as a rare complication due to barotrauma during colonoscopy: A case report and literature review

"Cat scratch colon" (CSC), characterized by spontaneous bright-red linear markings or mucosal laceration with bleeding due to air insufflation barotrauma, is a rare complication during colonoscopy. These mucosal lacerations can present as superficial tears that do not generally have clinical repercussions or as deeper tears that damage the muscularis and cause perforation. CSC occurs in the colon with submucosal stiffening disease, such as collagenous colitis; however, in cases unrelated to these diseases, CSC appears in the cecum or ascending colon for anatomical reasons. Herein, we report a case of CSC that caused cecal perforation. A 79-year-old woman underwent a colonoscopy for anal bleeding. Although insertion of the colonoscope was easy, as soon as the cecum expanded with air insufflation, the cecal mucosa was torn, and bleeding occurred. The endoscopist determined these findings as shallow mucosal tears and inactive bleeding, and a colonoscopy was completed. She visited our hospital 2 days after colonoscopy with a complaint of abdominal pain that appeared in the morning after colonoscopy. Computed tomography revealed inflammation around the cecum, with free air. Emergency surgery was performed to diagnose an iatrogenic colonic perforation caused by colonoscopy. During surgery, a necrotic area was found in the cecal wall, requiring ileocecal resection. The resected specimen showed cecal mucosal tears with necrosis, which were pathologically consistent with cecal rupture resulting from mucosal laceration. The postoperative course was uneventful. When CSC is encountered along with endoscopic findings of deep mucosal tears in the colon, the possibility of perforation after colonoscopy should be considered.

Cat Scratch Colon: A Case Report and Review of the Literature

We present a case of a 63-year-old woman with a history of compensated alcoholic cirrhosis and chronic kidney disease (CKD) who presented with a 3-day history of hematochezia. Initial laboratory results showed severe anemia with a hemoglobin level of 4.3 g/dl. She was then prepared for an esophagogastroduodenoscopy (EGD) and colonoscopy (CSP). The EGD showed moderate inflammation in the antrum and duodenal bulb without signs of bleeding. CSP revealed friable mucosa with spontaneous bleeding in the proximal ascending colon and cecum, indicating a cat scratch pattern. Additionally, non-bleeding prolapsed hemorrhoids were identified. The patient reported resolution of bleeding and tolerated diet advancement. We concluded that the bleeding was likely due to hemorrhoids. The patient was educated on conservative management of hemorrhoids and discharged in stable condition. During follow-up, the patient reported intermittent episodes of rectal bleeding. A repeat CSP conducted 6 months later revealed diffuse mild diverticulosis and non-bleeding prolapsed hemorrhoids were also observed. The histopathology of the colonic mucosa was normal. The patient was referred to a colorectal surgeon to discuss other treatment options for her hemorrhoids. We have also reviewed the literature related to this endoscopic finding and explored the similarities and differences in our case compared to those reported in the literature. Based on a comprehensive literature review and our patient's clinical course, we propose recommendations regarding the clinical significance and management strategies of CSC. Larger scale studies are needed to better define the underlying pathophysiology, predisposing factors, clinical implications, and optimal management of CSC.