A CASE OF THE PASSAGE OF A STRIPPED COLONIC MUCOSA

Abstract

A 77 year old woman was admitted to our hospital with anal bleeding. Colonoscopy revealed the polypoid mucosa in the sigmoid colon. Contrast medium enema revealed the flapping stripped mucosa easily pushed back to the descending colon by air pressure with diffuse circular ulceration of lower descending colon. The patient had taken warfarin potassium' for the anticoagulation therapy until the onset. The medication of warfarin was stopped and the conservative treatment with total parenteral nutrition was performed. Because healing tendency was confirmed by colonoscopy, anticoagulation therapy was started again. However the medication caused recurrent anal bleeding ten days later. So anticoagulation therapy with warfarin potassium was substituted for the antiplatelet therapy with aspirin. After 3 months, the ulcer was healed over with little stenosis. The passage of a stripped colonic mucosa have been rarely reported. In our case, this ulceration seemed to be caused not by ischemic colitis but by mucosal dissection due to submucosal hematoma, because colonoscopy revealed discreat regular margined ulcer without inflammation on the anal side of the ulcer lesion. Therefore, the passage of a colonic mucosa might have occurred from submucosal hematoma due to bleeding tendency by warfarin potas-sium.