COLONIC OBSTRUCTION SECONDARY TO SARCOIDOSIS - NONSURGICAL DIAGNOSIS AND MANAGEMENT

A 57-year-old black man presented with a 2-week history of abdominal p ain, weight loss, anorexia, and constipation. His history was signific ant for remote Hodgkin's disease and systemic sarcoidosis. Physical ex amination showed abdominal distention and hyperactive bowel sounds, pe riorbital swelling, and mandibular lymphadenopathy. A barium enema exa mination showed two high-grade obstructive lesions in the rectum and s plenic flexure. Colonoscopy confirmed the presence of the two areas of colonic obstruction. The mucosa showed diffuse fine ulcerations in th e areas of obstruction as well as in the intervening region. Endoscopi c 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 foll ow-up barium enema and colonoscopy performed after 1 month of steroid treatment were essentially normal. Mucosal biopsy specimens showed onl y mild nonspecific chronic inflammation of the lamina propria and no g ranulomas. Colonic involvement is rarely reported with systemic sarcoi dosis. We believe that this is the first report of colonic obstruction due to sarcoid diagnosed endoscopically and managed nonsurgically.