Melanosis coli in the elderly: a look beyond what can be seen

Case series Case 1 G.T., a 75-year-old nun, came to our observation because of an history of constipation. She had been diagnosed with a constipating-like irritable bowel syndrome, but constipation had worsened in the last months and was refractory to conventional laxatives. She was taking iron-based therapy which she was self-administrating since 3 years. She had undergone a sigmoidoscopy approximately one year before, and MC was observed. At clinical exam her abdomen was distended, and she had pain at palpation in right iliac fossa. Endoscopy was advocated and a stenosis was found at the recto-sigmoid junction. MC was observed. The endoscope could not be pushed further. Biopsies were taken, and these concluded for adenocarcinoma of the colon. The patient underwent FDG-PET-CT examination, which revealed an advanced disease with secondary lesions to liver and peritoneum. The patient refused endoscopic bowel stenting and an Hartmann procedure was performed. The surgical specimen showed MC before and after the colonic stenosis (Figure 1a). She received adjuvant chemotherapy. She died 48 months after surgery.