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Colonic perforation in collagenous colitis: a systematic review of a rare complication and guidance on management.
MedLine Citation:
PMID:  20464421     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: Collagenous colitis is an increasingly diagnosed clinical and pathological variant of microscopic colitis, mainly affecting middle-aged and elderly women; herein we review the literature for a rare complication (colonic perforation) and the most appropriate management.
METHODS: EMBASE, MEDLINE and abstracts from major gastroenterological congresses were searched in addition to hand-searching of electronic journals. Ten case reports and short series were identified as relevant to this study, and full papers of all these articles were obtained.
RESULTS: A total of 30 cases were recorded (28 female; age range 37-86 years, median 66 years). Colonic perforation was reported in 21 cases, mainly following colonoscopy (15 cases) or barium enema (4 cases). The site of colonic perforation/tears was predominantly right sided (17 cases). These cases were managed differently in different series, and none of the collagenous colitis-related colonic perforations that were treated conservatively (n = 5), or with diagnostic laparotomy but no colonic resection (n = 2), required further surgical intervention.
CONCLUSIONS: Conservative management of collagenous colitis-related perforation seems to be an appropriate initial approach. However, diagnosis of collagenous colitis is usually retrospective in colonic perforations related to endoscopy or barium enema, i.e. when the histology results are available, and it seems difficult to provide a management plan specific to these patients in the clinical setting. Therefore general guidelines for management of all colonoscopy- and barium enema-related perforation are required. When perforation occurs in an otherwise intact colon, diagnostic laparoscopy can be considered as appropriate initial management.
Authors:
Z Hussain; S Kelly; A Clarke; S Adams; G Miller
Publication Detail:
Type:  Journal Article     Date:  2010-05-13
Journal Detail:
Title:  Surgical endoscopy     Volume:  24     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  2930-4     Citation Subset:  IM    
Affiliation:
York Hospitals NHS Foundation Trust, York, UK.
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