Erdem SARI², Ahmet Deniz UÇAR², Savaş YAKAN², Fulya Yilmaz DURAN³, Nazif ERKAN², Mehmet YILDIRIM², Erkan OYMACI

KOLONOSKOPİDE NADİR RASTLANAN BİR OLGU: MELANOZİS KOLİ

Pseudomelanozis koli kolon mukozasının koyu pigmentasyonu ile karakterize, kolonoskopi sırasında saptanan yaygın bir durumdur. Sıklıkla antrakinon içeren laksatiflerin, konstipasyon nedeniyle aşırı kullanımına bağlı ortaya çıkan benign bir lezyon olduğu düşünülür. Kolorektal karsinomlarla olan ilişkisi son çalışmalarda tam olarak gösterilememiştir. Sıklıkla konstipasyonla ilişkilidir ve tanısı çoğunlukla endoskopik olarak veya histopatolojik incelemelerde tesadüfen konulur. Kesin bir tedavisi olmamakla birlikte, antrakinon içeren laksatiflerin kesilmesi ve konstipasyon yapıcı lifli gıdaların kullanımı önerilmektedir. Laksatiflerin kesilmesi ile birlikte genellikle aylar içinde gerileyebilir. Benign bir hastalık gibi görülmekle beraber kolorektal adenom ve karsinom şüphesinden dolayı pigmente ve nonpigmente alanlardan kolonoskopik biyopsiler alınmalıdır. Çalışmamızda, uzun süren konstipasyon ve laksatif kullanımı nedeniyle yapılan kolonoskopik incelemede melanozis koli saptadığımız, 22 yaşında bayan ve 55 yaşında erkek iki olguyu sunmayı amaçladık

Anahtar Kelimeler:

Melanozis, Laksatifler, Pigmentasyon, Konstipasyon

A RARE CASE IN COLONOSCOPIC INTERVENTION: MELANOSIS COLI

Melanosis coli are probably the most common pigmentation change seen in the colonic mucosa during endoscopic evaluation. It is well known a benign lesion that anthraquinones containing laxatives which excessive used for constipation are frequently the cause. Concern about a possible relationship between melanosis coli and the development of colonic neoplasms was not substantiated in recent studies. It is commonly related with constipation and diagnosed incidentally by the endoscopist or pathologist, especially within the colon, during investigations for constipation. Although treatment of this condition has not been established, recommendation is made to manage symptomatic constipation with fibercontaining foods and avoidance of anthraquinone cathartics. It can be regressed generally in a few months with the interrupting of laxatives. Although it is seen as a benign disease, colonoscopy biopsies should be taken from the pigmented and no pigmented areas because of the suspicion of colorectal adenoma and carcinoma. We describe two cases of melanosis coli occurring in a 22-year-old woman and 55 year-old man who took a laxative containing senna during colonoscopy intervention

Keywords:

Melanosis, Laxatives, Pigmentation, Constipation,

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) Batistatou A, Panelos J, Agnantis NJ. Melanosis intestine: case report. Diagnc Pathol 2006;1:3.
) Ghadially FN, Valley VM. Melanosis of the gastrointestinal tract. Histopathology ;25:197-207. ) Freeman HJ. ‘Melanosis’ in the small and large intestine. World J Gastroenterol ;14:4296-9.
) Speare GS. Melanosis coli. Experimental observations on its production and elimination in twenty-three cases. Am J Surg 1951;82:631-6.
) Mengs U, Rudolph RL. Light and electron-microscopic changes in the colon of the guinea pig after treatment with anthranoid and nonanthranoid laxatives. Pharmacology 1993;47:172.
) Balazs M. Melanosis coli. Ultrastructural study in 45 patients. Dis Colon Rectum ;29:839. ) Van Gorkom BAP, DeVries EGE, Karrenbeld A, Kleibeulier JH. Anthranoid laxatives and their potential carcinogenic effects. Aliment Pharmacol Ther 1999;13: 52.
) Çarlıoğlu A, Aytaç Ş, Eraslan E, Türkay C. Melanozis kolili bir olgu sunumu. Akademik Gastroenteroloji dergisi, 2007; :50-2.
) Badiali D, Marcheggiano A, Pallone F, et al. Melanosis of the rectum in patients with chronic constipation. Dis Colon Rectum 1985;28:241.
) Silva JGN, Brito TD, Laudanna AA, Sipahi AM. Histologic study of colonic mucosa in patients with chronic diarrhea and normal colonoscopic findings. J Clin Gastroenterol 2006;40:4.
) Koskela E, Kulju T, Collan Y. Melanosis coli: prevalance, distribution, and histo- logic features in 200 consecutive autopsies at Kuopio University central hospital. Dis Colon Rectum 1989;32:235-9.
) Li D, Browne LW, Ladabaum U. Melanosis Coli. Clin Gastroenterol Hepatol ;7:20. ) Siegers CP, Hertzberg-Lottin E von, Otte M, Schneider B. Anthranoid laxative abuse, a risk for colorectal cancer? Gut ;34:1099-101.
) Nusko G, Schneider B, Wittekind C, Hahn EG. Anthranoid laxative use is not a risk factor for colorectal neoplasia: Results of a prospective case control study. Gut ;46:651. Yazının alınma tarihi: 20.06.2014 Kabül tarihi: 18.09.2014 Online basım: 01.10.2014