UCTN – Unusual cases and technical notes E209 An unusual finding during screening colonoscopy: A cockroach! A 52-year-old woman with a history of Fig. 1 A nymph cock- depression was referred by her primary roach belonging to the physician for colorectal cancer screening. Blattellidae family, Blat- She had no family history of colorectal tella germanica (German cancer and a review of systems was posi- cockroach), was found tive for abdominal bloating. Bowel prep- in the transverse colon aration was done using 4 L of polyethy- on a routine screening lene glycol the evening prior to screening colonoscopy. colonoscopy. The procedure was uncom- plicated with no gross mucosal pathology, however, an insect was found in the trans- verse colon (●" Fig. 1). The insect was aspirated and sent to the lab for further identification. The insect had three body segments (head, thorax, and abdomen) with ventrodorsal flatten- ing of the body and a segmented abdo- men, three pairs of legs extending from the thorax (with spikes and claw-like terminal appendages), elongated hind legs, and a pair of elongated antennae ex- Fig. 2 Whole mount tending from the head to beyond the hind of the insect under a legs (●" Figs. 2 and 3). light microscope show- These morphologic findings were most ing three body seg- consistent with the nymph form of Blat- ments (head, thorax, and abdomen) with tella germanica (German cockroach) of ventrodorsal flattening the Blattellidae family, a common house- and segmented ab- hold pest. The patient had a cockroach in- domen (magnification festation at home and hence it was hypo- × 20). thesized that she may have inadvertently ingested a cockroach with food. Only a few cases of finding insects within the gastrointestinal tract have been de- scribed in the existing literature [1–7]. After a comprehensive MEDLINE search, our case is the third reporting any insect in the colon and the first reporting a cock- Fig. 3 Three pairs of roach in the colon or anywhere in the gas- legs originating from trointestinal tract [1,6]. Ants, wasps, lady- the thorax, with spikes This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. birds, bees, and yellow-jackets are among and claw-like terminal the other insects accidentally ingested appendages (magnifica- and found on endoscopy in the reported tion × 200). literature. The complex exoskeleton (“cu- ticle”) of the cockroach is probably re- sistant to the action of human digestive system. The insects are most likely carried into the gastrointestinal tract by the ac- cidental ingestion of infested or contami- nated food that serves as an inanimate vector. In many parts of the world, how- ever, cockroaches and other insects in their various forms are considered a form of food delicacy. Competing interests: None Kumar AR et al. Roach in the colon… Endoscopy 2010; 42: E209– E210 E210 UCTN – Unusual cases and technical notes Endoscopy_UCTN_Code_CCL_1AD_2AJ References Bibliography 1 Boardman CR, Sonnenberg A. Upping the DOI 10.1055/s-0030-1255712 “ ” – A. R. Kumar1, J. A. Perez1,2, R. Miick3, ant-e on endoscopic ant sightings. Gastro- Endoscopy 2010; 42: E209 E210 intest Endosc 2009; 70: 1245– 1246 © Georg Thieme Verlag KG Stuttgart · New York · Y. K. Govil1,2 2 Chaturvedi VN, Raizada RM, Behl R, Hasan W. ISSN 0013-726X 1 Department of Internal Medicine, Oesophageal foreign body: unusual mode of Albert Einstein Medical Center, entry and presentation. Indian J Chest Dis – Corresponding author Philadelphia, Pennsylvania, USA Allied Sci 1982; 24: 40 42 A. R. Kumar, MD, MPH 2 3 Girardi A. The bee: an unusual gastric for- Division of Gastroenterology and Albert Einstein Medical Center eign body. Endoscopy 1990; 22: 240 Nutrition, Albert Einstein Medical Center, 4 Houston HE. Letter: An unusual esophageal 5501 Old York Road Philadelphia, Pennsylvania, USA foreign body: dead or alive? Arch Surg Philadelphia 3 Department of Pathology and Labora- 1975; 110: 1516 Pennsylvania 19141 tory Medicine, Albert Einstein Medical 5 Kesseler P, Schoenemann J. Unusual summer- USA time foreign body in the esophagus. Endos- Fax: +215-456-7926 Center,, Philadelphia, Pennsylvania, USA copy 1999; 31: S24 [email protected] 6 Payen JL, Hervieu C, Couret B, Pascal JP. Im- ages in focus. A strange resident in the co- lon. Endoscopy 2000; 32: S51 7 Shaoul R, Rainis T. The new meaning of “ant- acid”. Gastrointest Endosc 2008; 67: 748 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Kumar AR et al. Roach in the colon… Endoscopy 2010; 42: E209 –E210.