Emergence of “cat scratch colon” during a colonoscopy

 

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We read with interest the article ”Cat scratch colon” by McDonnell et al. [1]. Red linear marks or parallel corkscrew lesions have been observed in the cecum and ascending colon [2] [3]. McDonnell et al. term these endoscopic findings ”cat scratch colon”, describing them as superficial breaks in the mucosa possibly secondary to barotrauma [1]. We report a case of colonoscopic barotrauma that emerged during a colonoscopy with reference to the article by McDonnell et al. [1].

A 74-year-old woman with positive fecal occult blood tests was referred for a total colonoscopy. She had no collagenous disease and no abdominal symptoms except for appetite loss. Laboratory testing revealed no anemia. The bowel was prepared with 100 g magnesium citrate and 1.8 L water. The processor and light source were a CV-240 (Olympus, Tokyo, Japan) and a CLV-U40D (Olympus). The air flow was 1.8 L/m. The colonoscope (CF-240AI; Olympus) was inserted into the terminal ileum and withdrawn to the ascending colon, which was then insufflated for observation. The cecum and ascending colon had no mucosal abnormality except for a lipoma of the ileocecal valve ([Fig. 1]). The colonoscope was then withdrawn to the transverse colon. Attempts were made to reinsert the colonoscope into the ascending colon to observe the hepatic flexure in more detail. However, reinsertion of the colonoscope became technically difficult. Red linear marks and parallel corkscrew lesions were observed in the cecum and ascending colon ([Fig. 2]), although no bleeding was evident. Histopathologic analysis of the biopsy specimens of the lesion showed no specific findings.

Fig. 1 Endoscopic view of the cecum and ascending colon before reinsertion of the colonoscope into the ascending colon.

Fig. 2 Endoscopic view of the cecum and ascending colon after reinsertion of the colonoscope into the ascending colon (area as for Figure 1). Red linear marks and parallel corkscrew lesions can be seen in the cecum and ascending colon.

We believe direct colonoscope trauma did not occur when the colonoscope traversed the ascending colon. The emergence of ”cat scratch colon” during endoscopy supports the possibility that this endoscopic finding is due to barotrauma.

Competing interests: None

References

• 1 McDonnell W M, Loura F, Pointon M J, Greenson J K. Cat scratch colon.  Endoscopy. 2007;  39 459-461
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• 2 Felig D M, Brand M H, Vender R J. Unexpected right colon mucosal bleeding on colonoscopy.  Gastrointest Endosc. 1996;  44 471-473
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• 3 Woltjen J A. A retrospective analysis of cecal barotrauma caused by colonoscope air flow and pressure.  Gastrointest Endosc. 2005;  61 37-45
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K. Tominaga, MD

Division of Gastroenterology

Department of Internal Medicine

Toho University Ohashi Medical Center

2-17-6 Ohashi, Meguro-ku

Tokyo 153-8515

Japan

Fax: + 81-3-34681269

Email: ktominaga@oha.toho-u.ac.jp