eP118 - Solitary Cecal Ulcer: A Case Report

Sunday, June 2, 2024

9:42 AM – 9:47 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Augustine A. Nguyen, BS

Fourth Year Medical Student
Burrell College of Osteopathic Medicine
Burrell College of Osteopathic Medicine
Baltimore, MD, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

KK

Kaylee A. Knaggs, BS

Fourth Year Medical Student
Burrell College of Osteopathic Medicine
Morgantown, West Virginia, United States

Disclosure information not submitted.
DR

Dusstyn Reynolds, BA, MA

Third Year Medical Student
Burrell College of Osteopathic Medicine
Roswell, New Mexico, United States

Disclosure information not submitted.
AG

Ana Laura Guzman, MD, FCAP

Surgical Pathologist
Pathology Consultants of New Mexico
Las Cruces, New Mexico, United States

Disclosure information not submitted.
ML

Mayin Lin, DO, MPH, FACS

Colorectal Surgeon
MercyOne Des Moines Surgical Group
Des Moines, Iowa, United States

Disclosure information not submitted.

Senior Author(s)

EA

Elia Charbel Abboud, MD, FACS

Colon and Rectal Surgeon
General Surgery Specialists, Eastern New Mexico Medical Group, and Burrell College of Osteopathic Medicine
Roswell, New Mexico, United States

Disclosure information not submitted.

Purpose/Background: Solitary cecal ulcer is a rare condition reported to be found in 0.1% of colonoscopies. The majority are idiopathic and resolve without further intervention, and only a minority of cases are associated with underlying disease. Possible underlying etiologies include malignancy, inflammatory bowel disease, intestinal tuberculosis, and ischemia. Chronic NSAID use has also been associated with this condition. The majority of solitary cecal ulcers are asymptomatic. Here, we report the case of a symptomatic idiopathic solitary cecal ulcer.Methods/Interventions: A 77-year-old female with a one-year history of right lower quadrant abdominal pain underwent a colonoscopy and was found to have a solitary cecal ulcer. This was biopsied and managed conservatively. A follow-up colonoscopy was performed 4 months later.Results/Outcomes: Pre-procedural computed tomography (CT) scan of the abdomen and pelvis showed uncomplicated diverticulosis and evidence of constipation. Colonoscopy revealed an ulcerated lesion of the ileocecal valve (Figure 1). This was a large cratered ulcer with exudate and an indurated base, involving about 20% of the bowel circumference. Multiple cold forceps biopsies were obtained. Pathology revealed colonic mucosa with detached fragments of fibrinopurulent exudate, consistent with an ulcer (Figure 2). There was no evidence of malignancy. The ulcer was managed conservatively with NSAID avoidance and treatment of constipation with psyllium husk fiber supplementation and increased water intake. Short-interval follow-up colonoscopy at 4 months revealed complete resolution of the ulcer (Figure 3).Conclusion/

Discussion: Solitary cecal ulcers are rare entities. Treatment is geared towards the cause, and histopathology is essential to rule out malignancy. Excluding circumstances such as hemorrhage and perforation, idiopathic solitary cecal ulcers are managed conservatively. Our patient did not require further treatment. Non-operative management alone was curative with complete resolution of the ulcer and associated abdominal symptoms."Figure 1.

Colonoscopic view of the solitary cecal ulcer.
Figure 2.

Ulcer pathology: Colonic mucosa with necroinflammatory debris (arrow).
Figure 3.

Colonoscopic views of the cecum before and after ulcer resolution."