title: Fractured colon: an endoscopically distinctive lesion associated with colonic perforation following colonoscopy in patients with collagenous colitis.
abstract: BACKGROUND
  Collagenous colitis is characterized by collagen deposition in the superficial colonic mucosa, beneath the surface epithelium, resulting in chronic nonbloody diarrhea of variable severity. The mucosa generally appears endoscopically normal.
  
  
  METHODS
  We report the occurrence of distinctive linear mucosal tears, unassociated with trauma, in 4 patients during diagnostic colonoscopy. The patients' tissue specimens were examined histologically, and clinical courses were recorded.
  
  
  METHODS
  Recognition of linear "fractures" was followed in 3 patients by colonic perforation. One patient required colectomy. Severe collagenous colitis was present in all. The resection specimen contained shallow linear ulcers overlying fibrotic submucosa, with pneumatosis and acute peritonitis.
  
  
  CONCLUSIONS
  We theorize that the stiffness of the colon in areas of collagenous colitis with submucosal fibrosis makes it susceptible to linear "fractures" during colonoscopic air insufflation with subsequent transmural air dissection. We urge extreme caution if this lesion is recognized at colonoscopy and recommend aborting the examination and obtaining plain radiographs to detect free intraperitoneal air.
authors.affiliation: Department of Medicine, New York University, New York, NY, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Sherman
authors.forename: John J
authors.initials: JJ
authors.lastname: Ackert
authors.forename: Roshini
authors.initials: R
authors.lastname: Rajapaksa
authors.forename: A Brian
authors.initials: AB
authors.lastname: West
authors.forename: Thaira
authors.initials: T
authors.lastname: Oweity
mesh_terms: D000368:Aged; D003093:Colitis, Ulcerative / Q000601:surgery*; D003106:Colon / Q000293:injuries*; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male