Miranda was responsible for the conceptualization and supervision of the project. The authors had no funding sources in the preparation of data or the manuscript. The authors have no conflicts of interest to declare. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Doctors should be aware of the severe complications underlying barotrauma such as colon perforation if care is not taken until conclusion of the colonoscopy.
It is relevant to identifying “cat scratch” colon as a benign condition. Cat scratch findings disappear naturally, so no other control colonoscopy is needed.
We consider and believe that the retroflexion maneuver was not the cause of the findings. The images were taken before and after a retroflexion maneuver was performed in the cecum to get the best possible image and to show the relationship with the ileocecal valve. CRP or fecal calprotectin were not demanded. Once the patient was diagnosed with barotrauma, the colonoscopy was abbreviated to avoid more serious injuries. Biopsies were not taken, although microscopic colitis might be associated with this finding. It is reasonable to think that these marks are inherent to a less complacent colon or associated with situations that can favor bleeding, so we accept that they can be observed in any case where the colon suffers a barotrauma during the colonoscopy regardless of an underlying clinical disease. Although colonoscopy by using CO 2 could be less traumatic because of the easy absorption of the gas, there is not enough evidence to suggest that it will avoid the barotrauma. In the present case the colonoscopy was performed by the process of air insufflation. It is widely accepted by most authors that the marks are caused by intramural bleeding associated with intestinal distension that is caused by insufflated air during the colonoscopy. Cat scratch is associated with the following conditions that lead to a less complacent colon or bleeding: collagenous colitis, a chronic inflammatory bowel disease that causes mucosal atrophy and impaired colonic compliance ischemic colitis because intestinal ischemia creates an edematous and fragile mucosa chronic cholestasis, which can impair absorption of vitamins K and A and cause bleeding predisposition and damage to the intestinal mucosal barrier integrity and chronic use of anti-inflammatory drugs that can lead to gastrointestinal toxicity and mucosal injury in the form of erosions and ulcers. Although this finding has no clinical implications, it may be a useful sign to prevent colonic perforation during colonoscopy. first described “Cat scratch” in 2007 and reported an 81% prevalence in females that was related to barotrauma from overdistension. c Relationships with the ileocecal valve. b The dotted surface suggests intraparietal bleeding. Ī Flat, red, bright, linear marks with well-defined boundaries are shown in the ascending colon and cecum. The colonoscopy, which had been easy up to this point, was ended after the diagnosis of cat scratch colon because of the risk of barotrauma and perforation. The remaining cecum, colon, and rectum presented normal vascular and mucous patterns. The streaks did not follow the arrangement of submucosal vessels and were distributed in parallel and perpendicular to each other (Fig. The colonoscopy revealed reddish, flat, bright streaks with sharp boundaries and dotted surfaces suggesting small bleeding points located in the ascending colon and cecum close to the ileocecal valve. Routine blood tests revealed a white blood cell count of 7,810/mm 2, a hemoglobin level of 10.6 g/dL, a platelet count of 327,000/mm 2, a serum creatinine level of 1.02 mg/dL, TSH 1.34 µIU/mL, and ferritin 365.1 ng/mL. Physical examination of the abdomen showed no masses, pain, or tenderness. The patient did not have a history of collagenous disease or cholestasis and denied having diarrhea, bleeding, weight loss, or family history of cancer colon.
She had a history of hypertension, hypothyroidism, and anxiety and had been taking losartan, hydrochlorothiazide, and thyrotoxin for 6 years. A 75-year-old woman underwent an elective colonoscopy for chronic abdominal pain and anemia.