Philip Kozan, MD1, Danny Issa, MD1, Mona Rezapour, MD, MHS2 1David Geffen School of Medicine at UCLA, Los Angeles, CA; 2University of California Los Angeles, West Hills, CA
Introduction: Segmental colitis is defined as mucosal inflammation confined to a colonic segment. There is an increasingly recognized entity termed segmental colitis associated diverticulosis (SCAD) that is distinct from Crohn’s Disease and ulcerative colitis. SCAD typically presents in elderly male patients with abdominal pain and bleeding and is a self-limiting inflammatory process. Here we describe an asymptomatic 63-year-old male with segmental colitis on screening colonoscopy, with a misleading neoplasm-like appearance.
Case Description/Methods: A 63-year-old male with no significant past medical history presented for colon cancer screening. His last colonoscopy was 11 years ago which was normal other than for diverticulosis. The patient was asymptomatic. Routine laboratory tests did not have evidence of an anemia, infection or inflammatory process.
On screening colonoscopy, the patient was noted to have extensive diverticulosis in the sigmoid colon (Figure 1a) but otherwise no notable mucosal abnormalities or bleeding in the remainder of the colon and a normal terminal ileum. At 20 cm, there was noted to be a large diverticulum with overlying blood and stool. Upon cleaning the area, a 1.5 cm flat polypoid lesion with irregular borders was found within the diverticulum (Figure 1b, 1c). The appearance of the lesion was concerning for neoplasm. The area was biopsied extensively with cold biopsy forceps. Pathology of the lesion revealed acute inflammation, focal ulceration, and crypt distortion consistent with segmental colitis (Figure 1d). The patient tolerated the procedure well and has continued to remain asymptomatic. A CT scan of the abdomen and pelvis was obtained to ensure the absence of other abnormality.
Discussion: SCAD is a unique clinical and pathological entity that often presents in elderly patients. Based on its appearance, it may be mistaken for a colonic neoplasm versus late-onset inflammatory bowel disease. Given this, the consequences of an inaccurate diagnosis may result in unnecessary treatment in an otherwise typically self-resolving process. This case highlights the need to recognize SCAD as part of the differential diagnosis and accurately identify it as a pathological diagnosis.
Figure: Figure 1. Segmental colitis appearance on colonoscopy. (a) Diverticulosis of the sigmoid colon. (b) Lesion identified in sigmoid diverticulum. (c) Additional view of the sigmoid diverticular lesion. (d) H&E stain of sigmoid diverticulum lesion consistent with chronic colitis, no dysplasia noted.
Disclosures: Philip Kozan indicated no relevant financial relationships. Danny Issa indicated no relevant financial relationships. Mona Rezapour: Abbvie – Speaker's Bureau. Takeda – Speaker's Bureau.
Philip Kozan, MD1, Danny Issa, MD1, Mona Rezapour, MD, MHS2. P2545 - A Tricky Imitator: An Unusual Presentation of Segmental Colitis Associated with Diverticulosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
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