Department of Surgery, Western Reserve Hospital Partners, Cuyahoga Falls, Ohio, USA.
Lincoln Memorial University Debusk College of Osteopathic Medicine, Harrogate, Tennessee, USA.
BMJ Case Rep. 2022 Oct 25;15(10):e250062. doi: 10.1136/bcr-2022-250062.
A patient was taken to the operating room with a presumptive diagnosis of necrotic small bowel and colon. During the procedure, it was noted that she had black mucosa throughout the colon. Several factors suggested viable colonic tissue, and the decision was made to not resect the colon as originally planned. Final pathology of the specimen would later reveal melanosis coli, an ultimately benign diagnosis. Further questioning of the patient found that she had taken a herbal laxative supplement containing several components which are known to cause melanosis coli. We hope that this case report will serve as a reminder to surgeons and clinicians to remember melanosis coli as a clinical entity when confronted with blackened or darkened colonic mucosa. On review of available literature, we identified other cases in which melanosis coli was discovered intraoperatively, and we propose a number of factors to support intraoperative decision making.
一位疑似患有坏死性小肠和结肠的患者被送往手术室。在手术过程中，发现她的整个结肠都有黑色的黏膜。有几个因素表明结肠组织仍有活力，因此决定不按原计划切除结肠。标本的最终病理将显示结肠黑变病，这是一个最终良性的诊断。进一步询问患者发现，她曾服用过一种含有几种已知会导致结肠黑变病成分的草药通便补充剂。我们希望这个病例报告能提醒外科医生和临床医生，当遇到结肠黏膜变黑或变暗时，要记住结肠黑变病这一临床实体。在回顾现有文献时，我们发现了其他一些术中发现结肠黑变病的病例，并提出了一些支持术中决策的因素。
