Colitis Cystica Profunda— A Rare Cause of Rectal Bleeding

We performed a colonoscopy on an 82-year-old female patient presenting with a history of rectal bleeding while receiving oral anticoagulation with rivaroxaban. At a height of about 40 to 50 cm from the anal verge, multiple cystic polypoid lesions with superficial erosive-erythematous changes were detected (Figure 1). On decapping by means of loop excision, these discharged liquid mucous material. The histological picture was one of mainly luminal edema with mild inflammation and mucinous cysts with no evidence of dysplasia (Figure 2). Based on the endoscopic and histological findings, the patient was diagnosed with colitis cystica profunda (CCP). CCP is a very rare benign condition of the colon characterized by the presence of intramural mucus-containing cysts. The etiology of the disease is not yet fully understood; established risk factors include chronic inflammatory and infectious bowel diseases. A typical clinical feature is the discharge of blood and mucous through the anus. In case of inconclusive findings, the diagnosis can be further supported by endosonography. Treatment with glucocorticoids can be initiated on a trial basis; however, in case of more severe signs and symptoms, segmental resection is required

Figure

Endoscopic findings with cystic-polypoid lesions as well as abnormal histological findings in H&E stained sections with presence of a pseudocyst with histiocytic wall (arrow) as well as mucin (asterisk)

Dr. med. Jonas Früh, Dr. med. Loraine Früh, Dr. med. Torsten Daubitz, Klinik für Innere Medizin, Klinikum Würzburg Mitte gGmbH,
Standort Missioklinik, [e-mail]

Conflict of interest: The authors declare no conflict of interest.

Translated from the original German by Ralf Thoene, M.D.

Cite this as: Früh J, Früh L, Daubitz T: Colitis cystica profunda—a rare cause of rectal bleeding. Dtsch Arztebl Int 2023; 120: 615.
DOI: 10.3238/arztebl.m2023.0272