大腸内視鏡検査中に消化管穿孔を来したCollagenous colitisの1例

抄録

An 85-year-old woman visited our hospital complaining of sustained watery diarrhea after starting a course of lansoprazole for treatment of gastroesophageal reflux disease. Routine laboratory studies and stool cultures were normal. A colonoscopy was performed during which it was technically easy to reach the cecum, however two mucosal lacerations were identified in the transverse colon on withdrawal of the scope. An abdominal CT scan taken immediately after colonoscopy showed free air. The patient was stable and successfully managed using a conservative course of antibiotics. Biopsy specimens of every colonic segment resulted in a diagnosis of collagenous colitis. A postulated mechanism for the mucosal lacerations might be the rigid character of the collagen containing subepithelium. Once collagenous colitis is suspected, colonoscopy should be performed more carefully, moreover, if mucosal lacerations are seen during colonoscopy, colonic perforation should be considered.