Ansari Ali Z, Hafeez Sahar, Jung Joel, Patibandla Srihita, Kim Peter S, Coffin Michael, Nguyen Alex, Kratz Kurt
Department of Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Department of Internal Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Cureus. 2024 Apr 7;16(4):e57792. doi: 10.7759/cureus.57792. eCollection 2024 Apr.
Chronic idiopathic ulcers of the colon pose diagnostic challenges due to their elusive etiology and potential resemblance to other intestinal pathologies, such as cecal carcinoma. This case report outlines the clinical course of a 68-year-old female patient who presented to the emergency department (ED) with persistent right lower quadrant pain. Despite multiple hospital visits yielding varied diagnoses, a definitive diagnosis was only made following a laparoscopic partial colectomy, which revealed chronic idiopathic ulcers with transmural scarring and adhesions to adjacent small intestine loops. Histological examination demonstrated a substantial ulcer bed populated by inflammatory cells, including large stellate and spindled stromal cells within the granulation tissue, alongside lymphoid hyperplasia and scar tissue extending into the muscularis propria. The initial presentation of this case could easily be mistaken for appendicitis, diverticulitis, carcinoma, or irritable bowel syndrome, highlighting the significance of considering chronic idiopathic ulcers in the differential diagnosis of patients presenting with cecal masses.
由于病因不明且可能与其他肠道疾病（如盲肠癌）相似，慢性特发性结肠溃疡带来了诊断挑战。本病例报告概述了一名68岁女性患者的临床病程，该患者因持续性右下腹疼痛就诊于急诊科。尽管多次住院就诊得出了不同诊断，但直到进行腹腔镜部分结肠切除术后才做出明确诊断，术中发现慢性特发性溃疡伴有透壁瘢痕形成以及与相邻小肠袢粘连。组织学检查显示溃疡底部有大量炎症细胞，包括肉芽组织内的大星状和梭形间质细胞，同时伴有淋巴组织增生和延伸至固有肌层的瘢痕组织。该病例的初始表现很容易被误诊为阑尾炎、憩室炎、癌或肠易激综合征，这凸显了在鉴别诊断出现盲肠肿物的患者时考虑慢性特发性溃疡的重要性。
