Sohrab Singh1, Rosemary Nustas, MD2, Cameron B. Body, MD2, Nikrad Shahnavaz, MD3
1Emory University Hospital, Ludhiana, Punjab, India; 2Emory University School of Medicine, Atlanta, GA; 3Emory University, Atlanta, GA
Introduction: Intestinal webs in adults are rare anomalies of the gastrointestinal tract associated with Non-Steroid Anti-inflammatory drug use often causing small bowel obstruction.1,2 The presence of a colonic web found incidentally on a follow-up colonoscopy in an asymptomatic adult patient makes our case unique.
Case Description/Methods: A 58-year old African American female with chronic NSAID (meloxicam) use for Ankylosing Spondylitis underwent elective superior hypophyseal artery aneurysm coil embolization without complications. After a drop in Hb and episode of melena, EGD and colonoscopy on 9/31/2018 revealed a superficial non-bleeding distal rectal ulcer, two duodenal ulcers and a pinpoint opening in the ascending colon, one fold distal to the cecum representing a Colonic Web (diaphragm) likely due to NSAID use. Lumen was narrow with no evidence of obstruction. Focused physical exam and imaging were benign. Patient was asked to stop NSAID and discharged on Proton Pump Inhibitor. Follow-up colonoscopy to assess ulcer healing on 12/18/2018 still showed the diaphragm but it was smaller and lumen was patent. No intervention was done again since patient was asymptomatic. Post procedure, she was discharged in stable condition and advised to continue avoiding NSAID, stay on stool softener and look for symptoms of obstruction.
Webs in the colon are a very rare entity. The investigation of choice remains capsule endoscopy or contrast study where non-passage of contrast distal to dilated segment in case of an obstructing colonic web indicates the level of obstruction. Intraoperative endoscopy and balloon dilatation help to relieve obstruction in symptomatic patients.3 No intervention is suggested in asymptomatic patients. Use of NSAID is the likely cause of development of web-like strictures in the small bowel.1,2 This case can be useful in the differential diagnosis of one of the rare causes of colonic obstruction.
Citation: Sohrab Singh; Rosemary Nustas, MD; Cameron B. Body, MD; Nikrad Shahnavaz, MD. P0206 - COLONIC WEBS - A CASE REPORT ABSTRACT. Program No. P0206. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.