Colonic obstruction secondary to sarcoidosis: nonsurgical diagnosis and management

A 57-year-old black man presented with a 2-week history of abdominal pain, weight loss, anorexia, and constipation. His history was significant for remote Hodgkin's disease and systemic sarcoidosis. Physical examination showed abdominal distention and hyperactive bowel sounds, periorbital swelling, and mandibular lymphadenopathy. A barium enema examination showed two high-grade obstructive lesions in the rectum and splenic flexure. Colonoscopy confirmed the presence of the two areas of colonic obstruction. The mucosa showed diffuse fine ulcerations in the areas of obstruction as well as in the intervening region. Endoscopic biopsy specimens showed numerous mucosal noncaseating granulomas but no acid-fast bacilli or foreign bodies. The patient was treated with oral prednisone and improved symptomatically within 3 days. The ocular lesions and lymphadenopathy also responded promptly. Findings of follow-up barium enema and colonoscopy performed after 1 month of steroid treatment were essentially normal. Mucosal biopsy specimens showed only mild nonspecific chronic inflammation of the lamina propria and no granulomas. Colonic involvement is rarely reported with systemic sarcoidosis. We believe that this is the first report of colonic obstruction due to sarcoid diagnosed endoscopically and managed nonsurgically.