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ISSN: 2165-7920
Journal of Clinical Case Reports
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A Case of Obstructive Colitis with Elevated Serum Carcinoembryonic Antigen

Hitoshi Kameyama*, Masayuki Nagahashi, Yuki Hirose, Natsuru Sudo, Yosuke Tajima, Masato Nakano, Yoshifumi Shimada, Takashi
Kobayashi, Shin-ichi Kosugi and Toshifumi Wakai
Niigata University, Niigata city, Japan
Corresponding Author : Hitoshi Kameyama
Niigata University, Niigata city, Japan
Tel: +81 25-223-6161
E-mail: [email protected]
Received October 09, 2015; Accepted November 04, 2015; Published November 11, 2015
Citation: Kameyama H, Nagahashi M, Hirose Y, Sudo N, Tajima Y, et al. (2015) A Case of Obstructive Colitis with Elevated Serum Carcinoembryonic Antigen. J Clin Case Rep 5:635. doi:10.4172/2165-7920.1000635
Copyright:© 2015 Kameyama H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

We report the case of a 72-year-old female who was admitted to our hospital because of obstructive colitis. Blood analysis showed her serum carcinoembryonic antigen (CEA) level to be 156.0 ng/mL. A sigmoidectomy and descending colostomy were performed for obstructive colitis due to colonic diverticulitis. Histopathological examination revealed active inflammation of the sigmoid colon without neoplasia. Her serum CEA level decreased within normal limits immediately after surgery.

Keywords
Carcinoembryonic antigen (CEA); Obstructive colitis; Diverticulitis; Colectomy
Introduction
The cell surface glycoprotein Carcinoembryonic Antigen (CEA) is commonly used as a tumor marker for various malignancies [1]. However, serum CEA levels sometimes increase secondary to benign diseases or conditions, including inflammatory bowel disease (IBD), liver disease, pancreatitis, and smoking [2]. Therefore, differential diagnosis with high serum CEA levels includes both benign and malignant disease.
Case Presentation
A 72-year-old female was admitted to our hospital because of abdominal pain. The physical examination showed a distended tympanic abdomen and tenderness in the left abdominal quadrant. Her medical history included hypertension and Alzheimer’s disease. She was 149.0 cm in height, weighed 42.8 kg, and did not smoke cigarettes. Her body temperature was 37.8°C, blood pressure was 160/80 mmHg, and pulse was 110 bpm with regular rhythm. Blood analysis showed a white blood cell count of 7,470 cells/mm3 and C-reactive protein level of 34.1 mg/dL. The level of her serum hemoglobin was 10.7 g/dL, blood urea nitrogen was 36.0 mg/dL, and creatinine was 1.1 mg/dL. Her serum CEA level was 156.0 ng/mL (normal value, < 5.0 ng/mL). An abdominal X-ray showed dilation of the large-bowel segment. An abdominopelvic Computed Tomography (CT) scan revealed a markedly dilated sigmoid colon with multiple colonic diverticula however, no malignant findings (Figure 1).
Obstructive colitis due to colonic diverticulitis was diagnosed and a sigmoidectomy and descending colostomy were performed. Histopathological examination revealed colonic diverticulitis without neoplasia. Her postoperative course was uneventful, and her serum CEA level decreased to within normal limits on postoperative day 18. On postoperative day 19, she was transferred to a psychiatric ward for the treatment of the Alzheimer’s disease. Her serum CEA level has remained within normal limits since discharge.
Case Discussion
CEA was first detected by Gold et al in 1965 [3,4]. It is a highly glycosylated protein with a molecular weight of approximately 180,000 [1]. In healthy individuals, CEA is produced in the colorectal mucosa, and then released into the gut lumen where it disappears immediately. CEA is well-known as a tumor marker for various malignancies. In colorectal cancer, the neoplastic cells located deep inside tumor glands become unpolarized and express CEA on their entire cell surface. As a result, exfoliated CEA can enter blood and lymphatic vessels through the intercellular spaces [5].
Serum CEA levels also increase in benign diseases or conditions, including IBD, liver cirrhosis, hepatitis, pancreatitis, and smoking [2]. Gardner et al. reported that in patients with ulcerative colitis (UC), 24% of mild relapses and 86% of severe relapses were accompanied by elevated CEA titers [6]. In UC, serum CEA concentrations increase because of the up-regulation of colonic epithelial CEA expression secondary to active mucosal inflammation.
levels [7]. In our case, serum CEA levels decreased to within normal limits immediately after colectomy. We speculate that serum CEA elevation may have resulted from active colorectal inflammation.
Conclusion
We report the case of obstructive colitis with an elevated serum CEA concentration. CEA release from inflamed colonic epithelia into the bloodstream may have caused this increase. We must remember that elevated serum CEA levels are sometimes caused by benign colorectal disease involving active inflammation.
References







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