The Practicing Endoscopist | Clinical Reference
Clinical Reference: Pathophysiology of "Cat Scratch Colon"
Diagnostic Evaluation & Protocol
1
Identify the Sign (Panels A-C)
Look for bright red, linear mucosal tears resembling cat scratches, typically in the right colon.
2
Evaluate Mechanism (Panels D-F)
Assess for sharp, tight distal angulation acting as a valve, trapping gas during insufflation.
3
Screen for Colitis
Consider underlying conditions weakening the mucosa, such as collagenous or ischemic colitis.
4
Determine Management
Recognize as a benign, incidental finding. No specific treatment or follow-up is required.
5
Prevent Barotrauma
Minimize insufflation pressure and use CO2 instead of room air when passing tight loops.
Figure 1: (A-C) Bright red, linear marks in the ascending colon. (D-F) Sharp, tight angulation responsible for causing the barotrauma.
Case Presentation
- Patient: 75F, obscure GI bleeding.
- Findings: Tortuous colon, diverticula, right-colon linear lacerations.
- Etiology: Barotrauma from gas entrapment at tight ascending colon angulation.
Clinical Pearls
Scope Passage: Avoid force when meeting resistance at sharp bends; loop reduction is key.
Biopsy Rule: Take biopsies of normal-looking mucosa if microscopic colitis is suspected.
Documentation: Note presence of tears to distinguish from active inflammatory colitis.