isolated cecal stricture secondary to nsaids use mimicking
TRANSCRIPT
Introduction
We present a rare case of isolated cecal stricture secondary to
excessive non-steroidal anti-inflammatory drugs (NSAIDs) use
mimicking colonic mass on diagnostic imaging of the abdomen.
Isolated Cecal Stricture Secondary to NSAIDs Use Mimicking Colonic Mass
Pranav Patel1, Tejas Raiyani
1, *Adey Hasan
1, Antwan Atia
2, Ravindra Murthy
3, Mark Young
2
1Department of Internal Medicine, 2 Department of Gastroenterology, East Tennessee State University 3Department of Gastroenterology, James H Quillen VA Medical Center, Johnson City, TN, United States.
Discussion • The effects of NSAIDs on the gastrointestinal system are well established.
• NSAIDs were first reported to cause colonic stricture in 1989 and since
then at least 50 cases has been reported.
• The most common site is the proximal ascending colon. NSAIDs were
described to cause diaphragmatic colonic stricture.
• Patients who have NSAIDs induced colonic stricture can present with
features mimicking colonic malignancy or can present acutely with
perforation. We present a rare case of isolated cecal stricture caused by
NSAIDs.
Case Description • 55-year-old male presented with sharp right lower Abdominal pain of two days.
• Pain was continuous and non-radiating without nausea, vomiting, fever, chills,
hematochazia or malena.
• H/o 1-2 firm bowel movements every day , good appetite with stable body weight.
• PMH: HTN, Dyslipidemia, GERD and Tubular adenomatous colon polyps
• Physical examination : Right lower quadrant and suprapubic tenderness.
• Labs: WBC 12.3/ mcL , HgB 12.6 g/dL , Normal CMP, LFT, coagulation and iron
studies
• CT Scan Abdomen : Large 6.3X 5.6 cm mass replacing cecum suspicious for colon
cancer.
• Colonoscopy : Large circumferential ulcerated stricture in the cecum.
• Biopsies : Ulcerated mucosa and underlying granulation tissue with prominent
endothelial cells.
• A cytokeratin AE1/3 stain did not show any infiltrating tumor cells in the
ulcerated areas.
• Upon further questioning of the patient, he has been taking 3 tablets of aspirin
daily and goody’s powder twice daily chronically.
• Patient was asked to avoid NSAIDs. References 1. Lang J, Price AB, Levi AJ, Burke M, Bjarnason I. Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol 1988;41(5):516-526. 2. Klein M, Linnemann D, Rosenberg J. Non-steroidal anti-inflammatory drug-induced colopathy. BMJ Case Rep. 2011 Feb 8;2011. 3. Khan AZ, George K, DeFriend DJ. Nonsteroidal anti-inflammatory drug-induced colonic stenosis: an unusual cause of a right-sided colonic mass: report of a case. Dis Colon Rectum. 2003 Mar;46(3):403-5. 4. El Hajj I, Hawchar M, Sharara A. NSAID-induced colopathy: case report and review of the literature. J Med Liban. 2009 Oct-Dec;57(4):274-6.
Colonoscopy showing Large circumferential ulcerated stricture in the cecum
CT showing Large Mass replacing Cecum suspicious
for colon cancer.
* Presenter