Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3380-3387
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3380
Colonic sarcoidosis: Unusual onset of a systemic disease
Paola Erra, Sonia Crusco, Loredana Nugnes, Anna Maria Pollio, Gianni Di Pilla, Giuseppe Biondi, Giovanni Vigliardi
Paola Erra, Sonia Crusco, Gianni Di Pilla, Department of Radiology and Nuclear Medicine, ASREM, “F. Veneziale” Hospital, 86070 Isernia, Italy
Loredana Nugnes, Anna Maria Pollio, Department of Pathological Anatomy and Histology: Cytodiagnostics, ASREM, “F. Veneziale” Hospital, 86070 Isernia, Italy
Giuseppe Biondi, Giovanni Vigliardi, Department of General Surgery, ASREM, “F. Veneziale” Hospital, 86070 Isernia, Italy
Author contributions: Vigliardi G and Erra P designed the report; Crusco S and Nugnes L collected the patient’s clinical data; Biondi G, Di Pilla G and Pollio AM performed the literature review; Erra P and Vigliardi G wrote the manuscript.
Ethics approval: Si comunica che in data 29/07/2014 il Comitato Eticl dell’Azienda Sanitaria Regionale del Molisc ha csaminato cd approvato I’articolo scientifico dal titolo “Unusual onset of colonic sarcoidosis a case report” redatto dai Dottori Paola Erra, Sonia Crusco, Loredana Nugnes, Anna Maria Pollio, Gianni Di Pilla, Giuseppe Biondi, Giovanni Vigliardi Dirigenti Medici in servizio presso ASREM Ospedale “F. Veneziale” di Isernia.
Informed consent: Il sottoscritto Barile Costantino, nato a Lamusei (OG), Italia, il 22.03.1955 concede il consenso al trattamento dei propri dati personali e all’utilizzo delle immagini relative alla propria patologia rilevata presso l’Ospedale “F.Veneziale” di Isernia (IS), Italia.
Conflict-of-interest: There are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Paola Erra, MD, Department of Radiology and Nuclear Medicine, ASREM, “F. Veneziale” Hospital, 1 Via Sant’Ippolito, 86070 Isernia, Italy.
Telephone: +11-39-0865442206 Fax: +11-39-0865442422
Received: October 5, 2014
Peer-review started: October 6, 2014
First decision: October 29, 2014
Revised: November 8, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: March 21, 2015

Sarcoidosis is a multisystem chronic inflammatory condition of unknown etiology that has the potential to involve every tissue in the body. Sarcoidosis in the gastrointestinal system, and particularly the colon, is very rare. Here, we report the case of a 57-year-old man with no previous diagnosis of sarcoidosis who presented with new onset of abdominal pain and constipation. A colonoscopy revealed that the abdominal pain was caused by an obstructing lesion in the cecum-ascending colon and lacked a clear histologic diagnosis. Radiologic investigation revealed concentric wall thickening of the cecum-ascending colon with multiple satellite lymphadenopathies, highly suggestive of a malignancy. The patient underwent a laparotomy and a right hemicolectomy was performed. A diagnosis of colonic sarcoidosis was made after the resected specimen was examined. Additionally, a chest computed tomography scan revealed lung involvement with atypical radiologic features in the absence of respiratory symptoms. Only histologic examination of the surgical specimen can yield a diagnosis of gastrointestinal sarcoidosis due to the non-specificity of endoscopic and radiologic findings.

Keywords: Colon, Sarcoidosis, Hemicolectomy, Systemic disease, Noncaseating granuloma

Core tip: Gastrointestinal tract involvement in systemic sarcoidosis is rare. This case report of a patient with gastrointestinal sarcoidosis is clinically relevant because the colonic location highlights an unusual cause of abdominal pain. This study provides an opportunity to clarify diagnostic criteria and therapeutic management for such a rare condition.