Obstructive Colitis Proximal to Obstructive Lesion of the Colon Cancer / 대한소화기내시경학회지

Obstructive colitis is a rare inflammatory condition that occurs in a dilated segment of the colon proximal to an obstructing lesion. A 69-year-old patient presented with abdominal pain and distension. The colonoscopy findings revealed a near total obstruction from sigmoid colon cancer. The mucosa of the obstructive lesion was erythematous and hemorrhagic but normal mucosa was found immediately above the 3 cm long obstructive lesion. The proximal bowel of the normal mucosa showed colitis with hemorrhagic mucosal changes and yellowish exudative plaques. Surgery was performed as a segmental resection after placing a metallic stent to decompress the proximal colonic loop. In conclusion, obstructive colitis should be considered if an ulcero-inflammatory lesion with a colonic obstruction and a skip lesion in the proximal colon are detected.

Obstructive Colitis Associated with Upper Rectal Cancer

Obstructive colitis refers to ulceroinflammatory lesions that occur in the colon proximal to an obstructing lesion. The pathogenesis is unclear, but raised intraluminal pressure, distension, and bacterial stasis are thought to play a role in the development of ischemia. The normal appearance at surgery may lead to involved segments of colon being used for anastomoses with consequent complications, so an awareness of the clinical, radiological, and endoscopic features of obstructive colitis is mandatory to prevent anastomotic complications. We experienced a case of obstructive colitis associated with a partially obstructing upper rectal cancer in a 67-year-old male. Obstructive colitis was diagnosed by using colonoscopy preoperatively, and an extended resection involving both the tumor and the colitis segment was performed without complications.

Obstructive Colitis Occuring Proximal to Colon Cancer / 대한소화기내시경학회지

Obstructive colitis is an ulceroinflammatory lesion occurring proximal to an obstructing lesion in the colon. It is the result of ischemia due to impairment of blood supply secondary to elevation of the intraluminal pressure and other factors which impair adequate perfusion. The incidence among patients with colonic obstruction is reported to be between 1 and 7%. The patients are predominantly female and usually have hypertension, diabetes, or other prior chronic disease. Obstruction is occurred most commonly in the rectosigmoid area. In half of the patients, this is caused by adenocarcinoma. There is always an abrupt transitional zone between affected and normal bowel. A segment of preserved mucosa is usually presented on the proximal side of the stenosis. Areas of colitis occurs either as circumscribed ulcers or confluent circumferential lesions. They can occur as early mucosal hemorrhage and edema, and transmural necrosis. Microscopically, lesions are composed of granulation tissue with mixed acute and chronic inflammatory cells that replace the mucosa and often the submucosa. We report a case of obstructive colitis occuring proximal to colon cancer with a brief review of relevant literature.

Obstructive Colitis: A Clinicopathologic Analysis of 7 Cases

Obstructive colitis is an ulceroinflammatory lesion of the large intestine at a distance proximal to the obstructing or potentially obstructing lesion of any etiology. It has been suggested that a rise in the intraluminal pressure related to the obstruction results in a fall in the intramural blood flow with subsequent ischemic necrosis. We examined 7 cases of surgically resected obstructive colitis associated with distal constrictive adenocarcinoma of the large intestine. Two cases of the obstructive colitis were radiologically suspected prior to surgery either as a separate tumor mass or diverticulosis, and another case was suggested to be a tumor seeding by colonoscopy. Grossly, five cases presented with single or multiple, shallow, well-demarcated ulcerative lesions, and the remaining two were featured with a segmental ulcerative lesion the with pseudopolypoid area. The ulceroinflammatory lesions were separated from the distal obstructive carcinoma by a skipped zone of relatively normal mucosa measuring 4-43 cm. The proximal colon to the obstructive lesions were obviously dilated except in one case. Microscopically, mucosa and submucosa were replaced by granulation tissue, and showed inflammatory cell infiltration and fibrin exudates. Muscle coat often accompanied ischemic contraction. Fissuring was noted in one case. The recognition of these lesions prior to or during surgery is stressed based on the morphological features corresponding to an ischemic change in the proximal mucosa to the primary obstructive lesion.