Department of Gastroenterology, Jinling Hospital, Jiangsu province, China.
BMC Gastroenterol. 2010 Oct 18;10:121. doi: 10.1186/1471-230X-10-121.
Cronkhite-Canada syndrome (CCS) is a rare multiple gastrointestinal polyposis. Up till now, many complications of CCS have been reported in the literature, but rib fracture is not included.
We report a case of a 58-year-old man who was admitted to our hospital with a 6-month history of frequent diarrhea, intermittent hematochezia and a weight loss of 13 kg. On admission, physical examination revealed alopecia of the scalp, hyperpigmentation of the hands and soles, and dystrophy of the fingernails. Laboratory data revealed hypocalcaemia and hypoproteinemia. Esophagogastroduodenoscopy, video capsule endoscopy and colonoscopy revealed various sizes of generalized gastrointestinal polyps. Histological examination of the biopsy specimens obtained from the stomach and the colon showed adenomatous polyp and inflammatory polyp respectively. Thus, a diagnosis of CCS was made. After treatment with corticosteroids for 24 days and nutritional support for two months, his clinical condition improved. Two months later, he was admitted to our hospital for the second time with frequent diarrhea and weight loss. The chest radiography revealed fractures of the left sixth and seventh ribs. Examinations, including emission computed tomography, bone densitometry test, and other serum parameters, were performed, but could not identify the definite etiology of the rib fractures. One month later, the patient suffered from aggravating multiple rib fractures due to the ineffective treatment, persistent hypocalcaemia and malnutrition.
This is the first case of a CCS patient with multiple rib fractures. Although the association between CCS and multiple rib fractures in this case remains uncertain, we presume that persistent hypocalcaemia and malnutrition contribute to this situation, or at least aggravate this rare complication. Besides, since prolonged corticosteroid therapy will result in an increased risk of osteoporotic fracture, CCS patients who accept corticosteroid therapy could be potential victims of rib fracture.
Cronkhite-Canada 综合征（CCS）是一种罕见的多发性胃肠道息肉病。到目前为止，CCS 的许多并发症已在文献中报道，但不包括肋骨骨折。
我们报告了一例 58 岁男性患者，因频繁腹泻、间歇性便血和体重减轻 13 公斤就诊。入院时，体格检查显示头皮脱发、手掌和足底色素沉着、指甲营养不良。实验室数据显示低钙血症和低蛋白血症。食管胃十二指肠镜、胶囊内镜和结肠镜检查显示大小不一的全胃肠道息肉。胃和结肠活检标本的组织学检查分别显示为腺瘤性息肉和炎性息肉。因此，诊断为 CCS。经过 24 天的皮质类固醇治疗和两个月的营养支持，他的临床状况有所改善。两个月后，他因频繁腹泻和体重减轻第二次入院。胸部 X 线片显示左侧第六和第七肋骨骨折。进行了包括发射型计算机断层扫描、骨密度测试和其他血清参数的检查，但未能确定肋骨骨折的确切病因。一个月后，由于治疗无效、持续低钙血症和营养不良，患者出现多发肋骨骨折加重。
这是首例 CCS 患者多发肋骨骨折。虽然本例 CCS 与多发肋骨骨折之间的关联尚不确定，但我们推测持续低钙血症和营养不良是导致这种情况的原因，或者至少加重了这种罕见的并发症。此外，由于长期皮质类固醇治疗会导致骨质疏松性骨折的风险增加，因此接受皮质类固醇治疗的 CCS 患者可能是肋骨骨折的潜在受害者。
