Cat Scratch Colon: A Case Report and Review of the Literature

We present a case of a 63-year-old woman with a history of compensated alcoholic cirrhosis and chronic kidney disease (CKD) who presented with a 3-day history of hematochezia. Initial laboratory results showed severe anemia with a hemoglobin level of 4.3 g/dl. She was then prepared for an esophagogastroduodenoscopy (EGD) and colonoscopy (CSP). The EGD showed moderate inflammation in the antrum and duodenal bulb without signs of bleeding. CSP revealed friable mucosa with spontaneous bleeding in the proximal ascending colon and cecum, indicating a cat scratch pattern. Additionally, non-bleeding prolapsed hemorrhoids were identified. The patient reported resolution of bleeding and tolerated diet advancement. We concluded that the bleeding was likely due to hemorrhoids. The patient was educated on conservative management of hemorrhoids and discharged in stable condition. During follow-up, the patient reported intermittent episodes of rectal bleeding. A repeat CSP conducted 6 months later revealed diffuse mild diverticulosis and non-bleeding prolapsed hemorrhoids were also observed. The histopathology of the colonic mucosa was normal. The patient was referred to a colorectal surgeon to discuss other treatment options for her hemorrhoids. We have also reviewed the literature related to this endoscopic finding and explored the similarities and differences in our case compared to those reported in the literature. Based on a comprehensive literature review and our patient's clinical course, we propose recommendations regarding the clinical significance and management strategies of CSC. Larger scale studies are needed to better define the underlying pathophysiology, predisposing factors, clinical implications, and optimal management of CSC.