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Martínez Díaz M, Costa Roig A, Carazo Palacios ME, Viguria Marco I, Marco Macián A, Crehuet Gramatyka D. Intestinal obstruction as a result of intra-abdominal hematoma: a complication of low molecular weight heparin in pediatric patients. Cir Pediatr 2024; 37:84-88. [PMID: 38623802 DOI: 10.54847/cp.2024.02.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Hematomas are a rare cause of intestinal obstruction. Subcutaneous heparin can bring about direct punctures on small bowel loops, potentially leading to traumatic hematoma and intestinal obstruction. CASE REPORTS We present three cases of pediatric patients with clinical signs of intestinal obstruction treated with subcutaneous heparin. Two cases had increased acute-phase reactants and radiological signs of intestinal suffering, so surgical treatment was decided upon, with intramural hematoma emerging as an intraoperative finding. The third case was conservatively managed with anticoagulant discontinuation and gut rest, since the patient had an adequate general condition and no findings compatible with ischemia or necrosis were noted in the complementary tests. DISCUSSION The administration of subcutaneous heparin may cause intestinal wall hematomas due to its anticoagulating effect and to the risk of inadvertent punctures on small bowel loops.
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Affiliation(s)
- M Martínez Díaz
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - A Costa Roig
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - M E Carazo Palacios
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - I Viguria Marco
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - A Marco Macián
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - D Crehuet Gramatyka
- Pediatric Surgery Department. Hospital Universitario Central de Asturias. Oviedo (Spain)
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Aravind N, Krishnappa N, Shafiq N, Malhotra P. Possible case of bortezomib-induced ileus paralytic. BMJ Case Rep 2024; 17:e257592. [PMID: 38383130 PMCID: PMC10882399 DOI: 10.1136/bcr-2023-257592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
This report describes a case of a patient with active multiple myeloma who was started on bortezomib, cyclophosphamide and dexamethasone and subsequently presented to the emergency department with acute intestinal obstruction one week later. The patient underwent exploratory laparotomy, but no mechanical cause of the obstruction was found. The patient later developed sepsis and eventually died. The possible cause of the intestinal obstruction was attributed to bortezomib, and the paper discusses the potential mechanism of this side effect and its management based on available literature.
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Affiliation(s)
- Nikhil Aravind
- Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niveditha Krishnappa
- Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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3
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Fang K, Wang J, Yuan J, Sui C, Zhi J, Xia Y, Sun M. Gastrointestinal perforation associated with bevacizumab in metastatic colorectal cancer. Cancer Rep (Hoboken) 2024; 7:e1952. [PMID: 38258341 PMCID: PMC10849927 DOI: 10.1002/cnr2.1952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To investigate the risk factors for gastrointestinal perforation in metastatic colorectal cancer patients receiving bevacizumab. METHODS We retrospectively reviewed 217 patients with metastatic colorectal cancer receiving bevacizumab to investigate the risk factors for gastrointestinal perforation. Three patients occurred intestinal perforation after receiving bevacizumab. We analyzed the clinical characteristics of three patients with intestinal perforation. RESULTS All patients receiving bevacizumab. Three of 217 patients occurred intestinal perforation after receiving bevacizumab. Patient no. 1 was 70 years old, female, having history of intestinal obstruction. The patient occurred intestinal perforation and ultimately died after receiving bevacizumab. Patient no. 2 was 59 years old, female, having history of intestinal obstruction. The patient occurred intestinal perforation after receiving bevacizumab, and recovered smoothly after symptomatic treatment. Patient no. 3 was 60 years old, female, having history of intestinal obstruction. The patient occurred intestinal perforation and ultimately died after receiving bevacizumab. CONCLUSIONS Patients with advanced colorectal cancer receiving bevacizumab are at risk of gastrointestinal perforation. The patient's age, gender and history of bowel obstruction may be associated with gastrointestinal perforation.
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Affiliation(s)
- Kunpeng Fang
- Department of Special Treatment IThird Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital)ShanghaiChina
| | - Jie Wang
- Department of Hepatic Surgery IIThird Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital)ShanghaiChina
| | - Jianyong Yuan
- Hepatobiliary Pancreatic Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Chengjun Sui
- Department of Special Treatment IThird Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital)ShanghaiChina
| | - Jiajun Zhi
- Department of Colorectal and Anal SurgeryXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yong Xia
- Department of Hepatic Surgery IVThird Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital)ShanghaiChina
| | - Minmin Sun
- Department of Hepatic Surgery IThird Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital)ShanghaiChina
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Hasegawa T, Sawada S, Saito T, Kohama M, Kajiyama K, Ishiguro C, Nonaka T, Okamura T, Iwasaki Y, Ueda T, Iguchi T, Horiuchi N, Uyama Y. Lower Risks of Gastrointestinal Perforation and Intestinal Obstruction in Patients with Atypical Antipsychotics in Comparison with Typical Antipsychotics Based on Real-World Data from the MID-NET ® in Japan. Ther Innov Regul Sci 2024; 58:192-199. [PMID: 37899426 PMCID: PMC10764367 DOI: 10.1007/s43441-023-00586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023]
Abstract
Intestinal perforation and obstruction are known to be one of the adverse events caused by antipsychotics; however, warning information on package inserts varies among antipsychotics. To investigate the risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics compared with those in patients prescribed typical antipsychotics, a nested case-control study was conducted utilizing real-world data from the MID-NET® medical information database in Japan. The study period spanned from January 1, 2009, to December 31, 2018. We found that the risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics were significantly lower than those in patients prescribed typical antipsychotics (adjusted odds ratio, 0.48; 95% confidence interval, 0.29-0.80). This finding was supported with prolonged periods for the exposure definition in the sensitivity analyses. In addition, no major differences in the risks of atypical antipsychotics, such as risperidone, quetiapine, olanzapine, and aripiprazole, were identified in this study. The safety profile regarding the lower risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics should be considered when choosing antipsychotics in clinical practice in terms of the proper use of such drugs.
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Affiliation(s)
- Tomoaki Hasegawa
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Sono Sawada
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
- IQVIA Solutions Japan K.K., Tokyo, Japan
| | - Tomoyuki Saito
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Mei Kohama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Kazuhiro Kajiyama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Chieko Ishiguro
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
- Section of Clinical Epidemiology, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Nonaka
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
- Department of Health and Medical Innovation, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Toshiyuki Okamura
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Yukari Iwasaki
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Takahiro Ueda
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Toyotaka Iguchi
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Naoya Horiuchi
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Yoshiaki Uyama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan.
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Affiliation(s)
- Sabo Tanimu
- Department of Gastroenterology, Marshfield Clinic, Weston, Wisconsin, USA
| | - Cray Williams
- Department of Surgery, Marshfield Clinic, Weston, Wisconsin, USA
| | - Adedayo A Onitilo
- Department of Oncology/Hematology, Marshfield Clinic, Weston, Wisconsin, USA
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Stasi E, De Santis S, Cavalcanti E, Armentano R. Iatrogenic Kaposi sarcoma of the terminal ileum following short-term treatment with immunomodulators for Crohn disease: A case report. Medicine (Baltimore) 2019; 98:e15714. [PMID: 31096523 PMCID: PMC6531216 DOI: 10.1097/md.0000000000015714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease. PATIENT CONCERNS We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection. DIAGNOSES The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8. INTERVENTIONS AND OUTCOMES The patient underwent surgical resection and is disease free at 6 years follow-up. LESSONS This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.
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Affiliation(s)
| | - Stefania De Santis
- Laboratory of Experimental Immunopathology, National Institute of Gastroenterology “S. de Bellis,” Research Hospital Castellana Grotte, Bari
- University of Salerno, Department of Pharmacy, Fisciano (SA)
| | - Elisabetta Cavalcanti
- Histopathology Unit, National Institute of Gastroenterology “S. de Bellis,” Research Hospital Castellana Grotte, Bari, Italy
| | - Raffaele Armentano
- Histopathology Unit, National Institute of Gastroenterology “S. de Bellis,” Research Hospital Castellana Grotte, Bari, Italy
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8
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Abstract
Althoughtricyclic antidepressants(TCAs) are frequently prescribed to patients with depression, these drugs can also be misused. A 21-year-old comatose patient was referred to our hospital presenting with ventricular tachycardia. Despite initial treatment including intravascular lipid emulsion, ventricular fibrillation occurred soon after arrival. Venoarterial extracorporeal membrane oxygenation and therapeutic hypothermia were administered. Refractory arrhythmia disappeared on the next day. A high concentration of amitriptyline was identified in his blood samples on arrival. Mechanical bowel obstruction followed after abdominal compartment syndrome caused by anticholinergic effects, and refractory seizure occurred due to TCA intoxication. Although seizure was brought under control with anticonvulsant agents, his Glasgow Coma Scale did not recover to the full score. MRI presented irreversible damage to the bilateral frontal lobe and insula. Amitriptyline has the potential to cause unusual serious complications, such as abdominal compartment syndrome, irreversible central nervous system disability and lethal arrhythmia.
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Affiliation(s)
- Takeshi Nishimura
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Hayato Maruguchi
- Department of Plastic Surgery, Kobe University Hospital, Kobe, Japan
| | - Atsunori Nakao
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
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Zhang ZM, Lin XC, Ma L, Jin AQ, Lin FC, Liu Z, Liu LM, Zhang C, Zhang N, Huo LJ, Jiang XL, Kang F, Qin HJ, Li QY, Yu HW, Deng H, Zhu MW, Liu ZX, Wan BJ, Yang HY, Liao JH, Luo X, Li YW, Wei WP, Song MM, Zhao Y, Shi XY, Lu ZH. Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon. World J Gastroenterol 2017; 23:3934-3944. [PMID: 28638234 PMCID: PMC5467080 DOI: 10.3748/wjg.v23.i21.3934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/04/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of drug-induced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids.
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MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/therapy
- Anti-Bacterial Agents/therapeutic use
- Biopsy
- Colectomy/methods
- Colon, Sigmoid/diagnostic imaging
- Colon, Sigmoid/drug effects
- Colon, Sigmoid/pathology
- Colon, Sigmoid/surgery
- Colonography, Computed Tomographic
- Colonoscopy/instrumentation
- Colonoscopy/methods
- Constipation/etiology
- Constriction, Pathologic/chemically induced
- Constriction, Pathologic/complications
- Constriction, Pathologic/diagnosis
- Constriction, Pathologic/therapy
- Contrast Media/administration & dosage
- Diagnosis, Differential
- Diarrhea/diagnosis
- Diarrhea/etiology
- Diarrhea/microbiology
- Diatrizoate Meglumine/administration & dosage
- Dilatation/methods
- Drugs, Chinese Herbal/adverse effects
- Female
- Fluid Therapy
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/therapy
- Humans
- Inflammatory Bowel Diseases/diagnosis
- Intestinal Obstruction/chemically induced
- Intestinal Obstruction/complications
- Intestinal Obstruction/diagnosis
- Intestinal Obstruction/therapy
- Laparoscopy/methods
- Levofloxacin/therapeutic use
- Middle Aged
- Pityriasis Rosea/drug therapy
- Self Expandable Metallic Stents
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10
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Sugimoto A, Tada M, Taji T, Houjo Y, Kanokogi Y, Hirata M, Fujita Y, Kawasaki Y, Sakamoto T, Yoshikawa J, Iwama H, Usuki S, Shirakata Y, Tamura J, Maki A. [A Case of Malignant Lymphoma of the Jejunum That Developed Stenosis and Perforation after a Complete Response to Chemotherapy]. Gan To Kagaku Ryoho 2017; 44:341-343. [PMID: 28428518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 57-year-old woman was admitted owing to epigastric pain.Abdominal computed tomography demonstrated a tumor in the origin of the jejunum.After an endoscopic biopsy, we diagnosed diffuse large B-cell lymphoma.We treated her with CHOP chemotherapy because pancreaticoduodenectomy is highly invasive.After 1 course of chemotherapy, the tumor was reduced.However, she developed a jejunal stenosis; therefore, we performed laparoscopic gastrojejunostomy.Furthermore, she developed perforated peritonitis on the sixth day after the surgery, and therefore, an emergency partial jejunum resection was performed.Histopathologically, viable lymphoma cells were not found in the resected intestine.She had a complete response 10 months after the surgery.Chemotherapy may cause intestinal stenosis and perforation requiring surgery; therefore, decisions about surgical procedures must be made carefully.
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Affiliation(s)
- Atsushi Sugimoto
- Dept. of Surgery, Hyogo Prefectural Amagasaki General Medical Center
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11
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Frye JM, Hansel SL, Dolan SG, Fidler JL, Song LMWK, Barlow JM, Smyrk TC, Flicek KT, Hara AK, Bruining DH, Fletcher JG. NSAID enteropathy: appearance at CT and MR enterography in the age of multi-modality imaging and treatment. ACTA ACUST UNITED AC 2016; 40:1011-25. [PMID: 25666969 DOI: 10.1007/s00261-015-0367-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CT and MR enterography and capsule endoscopy are increasingly used as routine diagnostic tests for patients with potential small bowel disorders and obscure gastrointestinal bleeding. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used drugs that disrupt prostaglandin synthesis and result in a variety of localized complications within the small bowel ranging from ulcer formation to characteristic circumferential strictures, or diaphragms. NSAID enteropathy encompasses this spectrum of acute and chronic inflammatory sequelae, and is associated with typical findings at capsule endoscopy and surgery. Herein we review the typical clinical presentation of NSAID enteropathy, in addition to its endoscopic appearances, focusing on imaging findings at cross-sectional enterography. Multiple, short-segment strictures are the hallmarks of imaging diagnosis. Strictures may have minimal hyperenhancement or wall thickening, but these findings are typically symmetric and circumferential with respect to the bowel lumen. Multifocal Crohn's strictures, and occasionally radiation-induced strictures or adhesions, will mimic NSAID diaphragms. Multi-phase or multi-sequence imaging at CT and MR enterography increase diagnostic confidence in stricture presence. Strategies for subsequent workup and therapy after enterography are also discussed. Given the frequent use of NSAIDs and typical appearance of these strictures, knowledge of characteristic imaging findings can be particularly useful when evaluating patients with anemia and recurrent small bowel obstruction.
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Affiliation(s)
- Judson M Frye
- Department of Radiology, Mayo Clinic Health System, La Crosse, WI, USA
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Gliptins, exenatide, liraglutide: "intestinal obstruction". Prescrire Int 2016; 25:17. [PMID: 26942257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Reduced gastrointestinal motility exposes to potentially serious consequences.
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13
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Autmizguine J, Hornik CP, Benjamin DK, Laughon MM, Clark RH, Cotten CM, Cohen-Wolkowiez M, Benjamin DK, Smith PB. Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics 2015; 135:e117-25. [PMID: 25511117 PMCID: PMC4279070 DOI: 10.1542/peds.2014-2141] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on clinical outcomes in very low birth weight (≤1500 g) infants. METHODS We identified very low birth weight infants with NEC from 348 US NICUs from 1997 to 2012. Anaerobic antimicrobial therapy was defined by antibiotic exposure on the first day of NEC. We matched (1:1) infants exposed to anaerobic antimicrobial therapy with infants who were not exposed by using a propensity score stratified by NEC severity (medical and surgical). The primary composite outcome was in-hospital death or intestinal stricture. We assessed the relationship between anaerobic antimicrobial therapy and outcome by using a conditional logistic regression on the matched cohort. RESULTS A total of 1390 infants exposed to anaerobic antimicrobial therapy were matched with 1390 infants not exposed. Mean gestational age and birth weight were 27 weeks and 946 g, respectively, and were similar in both groups. We found no significant difference in the combined outcome of death or strictures, but strictures as a single outcome were more common in the anaerobic antimicrobial therapy group (odds ratio 1.73; 95% confidence interval, 1.11-2.72). Among infants with surgical NEC, mortality was less common with anaerobic antimicrobial therapy (odds ratio 0.71; 95% confidence interval, 0.52-0.95). CONCLUSIONS Anaerobic antimicrobial therapy was not associated with the composite outcome of death or strictures but was associated with an increase in intestinal strictures. This higher incidence of intestinal strictures may be explained by the fact that death is a competing outcome for intestinal strictures, and mortality was slightly lower in the anaerobic cohort. Infants with surgical NEC who received anaerobic antimicrobial therapy had lower mortality.
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Affiliation(s)
| | - Christoph P Hornik
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Daniel K Benjamin
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Matthew M Laughon
- Division of Neonatal-Perinatal Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida; and
| | - C Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Daniel K Benjamin
- John E. Walker Department of Economics, Clemson University, Clemson, South Carolina
| | - P Brian Smith
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina;
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14
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Abstract
OBJECTIVES To examine the risk of bowel obstruction in older adults during treatment with extended-release nifedipine compared with patients treated with amlodipine. DESIGN Retrospective cohort study using multiple linked healthcare databases. SETTING Ontario, Canada from 1 April 1997 to 31 December 2010. PARTICIPANTS We identified patients aged 66 years and older who started treatment with Adalat XL, an extended-release nifedipine product employing a tablet delivery system associated with mechanical bowel obstruction. For comparison, we studied patients receiving amlodipine, a long-acting calcium channel blocker that does not utilise the same delivery system and has not been implicated as a cause of bowel obstruction. Propensity score matching was used to ensure similarity of patients receiving the two drugs. PRIMARY OUTCOME MEASURE HR for the association between extended-release nifedipine relative to amlodipine and hospitalisation for bowel obstruction during therapy. RESULTS Over the 13-year study period, we identified 103 657 patients treated with extended-release nifedipine and 204 733 patients treated with amlodipine. In these two groups, 591 (0.6%) and 1185 (0.6%) of patients were hospitalised for bowel obstruction, respectively. We found no difference in the risk of bowel obstruction among patients treated with extended-release nifedipine compared with amlodipine (HR 1.09, 95% CI 0.96 to 1.24). CONCLUSIONS Bowel obstruction during treatment with extended-release nidefipine is rare, and the risk is not appreciably greater than that during treatment with amlodipine.
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Affiliation(s)
- David N Juurlink
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Chelsea Hellings
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Center, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anjie Huang
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - J Michael Paterson
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David R Urbach
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad M Mamdani
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Center, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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15
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Tongyoo A, Sriussadaporn E, Limpavitayaporn P, Mingmalairak C. Acute intestinal obstruction due to Kalimate, a potassium-lowering agent: a case report and literature review. J Med Assoc Thai 2013; 96:1617-1620. [PMID: 24511728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sodium polystyrene sulfonate (Kayexalate) and calcium polystyrene sulfonate (CPS, Kalimate) are commonly used to reduce serum potassium. There were some published evidences of severe gastrointestinal complications from the administration of these agents such as colonic necrosis with or without perforation and acute obstruction. The authors reported a 52-year-old male patient being critically ill from severe soft tissue infection of the right leg and sepsis. Hyperkalemia had occurred due to renal insufficiency and required several doses of Kalimate to reduce the serum potassium level. Subsequently, the patient developed complete intestinal obstruction and an exploratory laparotomy was performed. The intra-operative findings were distended stomach and the small bowel contained a large amount of intraluminal affected Kalimate that was removed via gastrotomy and enterotomy. These findings suggested that the inspissated Kalimate could lead to significant obstruction of the gastrointestinal tract in some groups of patient.
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Affiliation(s)
- Assanee Tongyoo
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathumthani, Thailand.
| | - Ekkapak Sriussadaporn
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathumthani, Thailand
| | - Palin Limpavitayaporn
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathumthani, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathumthani, Thailand
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Zamani N. Authors'reply. Int J Occup Environ Med 2013; 4:219-220. [PMID: 24396921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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17
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Esfahani AHN. Toluene 2,4-diisocyanate and bowel obstruction: occupational medicine aspect of a case report. Int J Occup Environ Med 2013; 4:218-220. [PMID: 24141872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/21/2013] [Indexed: 06/02/2023]
Affiliation(s)
- A H Naseri Esfahani
- Occupational Sleep Research Center (OSRC), Tehran University of Medical Sciences, Tehran, Iran.
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18
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Shadnia S, Ahmadimanesh M, Ghazi-Khansari M, Zamani N. Intestinal obstruction in acute inhalational toluene 2,4-diisocyanate gas toxicity. Int J Occup Environ Med 2013; 4:164-166. [PMID: 23860547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/02/2013] [Indexed: 06/02/2023]
Abstract
The isocyanates are widely used as precursors of polyurethane products, as well as carbamate insecticides. Toluene 2,4-diisocyanate (TDI) is one of the most important commercially used isocyanates. Humans may be exposed to TDI by inhalation, ingestion, dermal and eye contact. TDI is a powerful irritant to the mucosal membranes of the gastrointestinal and respiratory tracts, eyes and the skin. Pulmonary manifestations, especially occupational asthma, are the predominant manifestations after TDI toxicity. Herein, we present intestinal obstruction as an extraordinary manifestation of acute TDI toxicity after occupational exposure. TDI toxicity may cause intestinal obstruction.
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Affiliation(s)
- S Shadnia
- Toxicological Research Center, Clinical Toxicology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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Abstract
Neutropenic enterocolitis is a common gastrointestinal complication in children undergoing chemotherapy for a variety of malignancies. It usually involves ileum and caecum, and involvement of rectum has rarely been reported. The authors report neutropenic enterocolitis in a child undergoing chemotherapy for acute lymphoblastic lymphoma which presented with ileus along with a mass like lesion in the rectum.
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Affiliation(s)
- Shuchita Gupta
- Department of Pediatrics, MAMC and Associated Lok Nayak Hospital, New Delhi, India
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20
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Neuroleptics: intestinal occlusion. Antimuscarinic effects. Prescrire Int 2011; 20:241. [PMID: 21970089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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21
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Schreinemacher MH, Bloemen JG, van der Heijden SJ, Gijbels MJ, Dejong CH, Bouvy ND. Collagen fleeces do not improve colonic anastomotic strength but increase bowel obstructions in an experimental rat model. Int J Colorectal Dis 2011; 26:729-35. [PMID: 21344301 PMCID: PMC3098973 DOI: 10.1007/s00384-011-1158-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate whether a collagen fleece kept in place by fibrin glue might seal off a colorectal anastomosis, provide reinforcement, and subsequently improve anastomotic healing. METHODS Wistar rats underwent a 1-cm left-sided colonic resection followed by a 4-suture end-to-end anastomosis. They were then randomly assigned to one of three treatment groups: no additional intervention (control, n = 20), the anastomosis covered with fibrin glue (fibrin glue, n = 20), the anastomosis covered with a collagen fleece, kept in place with fibrin glue (collagen fleece, n = 21). At either 3 or 7 days follow-up, anastomotic bursting pressure was measured and tissue was obtained for histology and collagen content assessment after which animals were sacrificed. RESULTS Three rats in the control (15%), three in the fibrin glue (15%), and one in the collagen group (4.8%) died due to anastomotic complications (P = 0.497). Anastomotic bursting pressures were not significantly different between groups at 3 and 7 days follow-up (P = 0.659 and P = 0.427, respectively). However, bowel obstructions occurred significantly more often in the collagen group compared to the control group (14/21 vs. 3/20, P = 0.003). Collagen contents were not different between groups, but histology showed a more severe inflammation in the collagen group compared to the other groups at both 3 and 7 days follow-up. CONCLUSIONS A collagen fleece kept in place by fibrin glue does not improve healing of colonic anastomoses in rats. Moreover, this technique induces significantly more bowel obstructions in rats, warranting further study before being translated to a clinical setting.
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Affiliation(s)
- Marc H Schreinemacher
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6200 Maastricht, The Netherlands.
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22
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Clozapine: ileus. Prescrire Int 2008; 17:160. [PMID: 19492492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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23
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Sevelamer: constipation and occlusion. Complications, sometimes fatal. Prescrire Int 2008; 17:111. [PMID: 18630352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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24
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Schmidtko J, Truninger K, Gugger M, Cottagnoud P, Stucki A. [What is your diagnosis? Diaphragma disease]. Praxis (Bern 1994) 2008; 97:117-118. [PMID: 18549011 DOI: 10.1024/1661-8157.97.3.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- J Schmidtko
- Klinik und Poliklinik für Allgemeine Innere Medizin, Inselspital Bern
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25
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Kerr JP, Turner M, Ashton-Key M, Mead GM, Johnson PWM. Intestinal strictures: a new complication of treatment for primary gastrointestinal diffuse large B-cell lymphoma. Br J Haematol 2008; 140:712-4. [PMID: 18218049 DOI: 10.1111/j.1365-2141.2007.06950.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Lapner MA, Stephen WJ. Rofecoxib associated with diaphragm disease. Can J Surg 2007; 50:E27-E28. [PMID: 18067698 PMCID: PMC2386224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Michael A Lapner
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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27
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Keeling AN, Davis JL, Williams A, Sabharwal T, Adam A. Fluoroscopically guided balloon dilation of NSAID-induced colonic diaphragm. J Vasc Interv Radiol 2007; 18:1060-2. [PMID: 17675630 DOI: 10.1016/j.jvir.2007.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
BACKGROUND There is controversy about preoperative chemotherapy in the treatment of Wilms' tumor. The perioperative morbidity plays a key role in this discussion. Therefore, risk factors of perioperative complications were analysed in our series of patients with Wilms' tumor with a special focus on the effects of preoperative chemotherapy. PATIENTS AND METHODS Case histories of 37 patients [mean age 3.9 (range: 0.6 - 14) years] were retrospectively analysed concerning follow-up, clinical and histopathological stage, size of the primary tumor, as well as duration and extent of preoperative chemotherapy. RESULTS 35 patients underwent radical nephrectomy, 2 patients had organ-sparing surgery because of bilateral involvement. The mean maximal tumor diameter was 9.5 cm (range: 4 - 24 cm). 11/37 patients had no or shortened preoperative chemotherapy. 6/37 patients (16.2 %) had perioperative complications. There was one intraoperative tumor rupture, 4 small bowel obstructions, 1 pancreatitis. All complications occurred in patients of clinical stages III and IV, maximal tumor diameter > 10 cm after unusually extended operative procedures. 4 patients showed only poor response to preoperative chemotherapy. Patients with doxorubicin pre-treatment showed a higher risk of postoperative small bowel obstruction. CONCLUSIONS The risk of perioperative complications was correlated with the local extent of the primary tumor and was higher with those requiring more extensive surgical interventions. The influence of preoperative chemotherapy on the complications rate is inconstant. Considering a good response of the primary tumor, the complication rate will be decreased. However, the comorbidity of more intense preoperative chemotherapy in patients of stage IV may contribute to a higher risk of surgical complications.
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Affiliation(s)
- F Seseke
- Klinik für Urologie, Georg-August-Universität, Robert-Koch-Strasse 40, 37075 Göttingen.
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Abstract
A group of neonates born by elective Caesarean delivery to HIV infected mothers taking the antiretroviral agent Zidovudine, are presented. The three newborns were also treated with Zidovudine immediately postnatally, and developed functional distal bowel obstruction. The bowel obstruction resolved with conservative management and cessation of the oral antiretroviral agent. The combination of caesarian delivery and antiretroviral agents should be considered as a possible cause for delayed meconium passage and a functional distal bowel obstruction.
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Affiliation(s)
- N M Brindley
- The Royal Hospital for Sick Children, York Hill, Glasgow, Scotland, United Kingdom.
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31
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Ivnitsky JJ, Rejniuk VL, Schäfer TV, Malakhovsky VN. Fulminant hyperammonaemia induced by thiopental coma in rats. Toxicology 2006; 224:184-90. [PMID: 16704891 DOI: 10.1016/j.tox.2006.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 04/03/2006] [Accepted: 04/04/2006] [Indexed: 11/29/2022]
Abstract
Fulminant hyperammonaemia as a threshold effect of coma-inducing dose of sodium thiopental has been revealed in rats. Blood ammonia content increased progressively after the introduction of 1.0 LD(50) (but not 0.8 LD(50)) of sodium thiopental three times in 3h and five times in 18h. The urinary ammonia excretion was not impaired while the volatilization of ammoniac from the body of ST-treated rats was higher, giving evidence of the augmentation of ammonia production. Blood urea increased by one third despite of insignificant alterations of haematocrit and blood creatinine. Ammonia hyperproduction in the digestive tract could result from gastrointestinal stasis, which has been verified by roentgenography and confirmed by correlation of hyperammonaemia with the stool retardation. In thiopental coma rats the slope of a dose-dependent increase of the blood ammonia and the blood urea after the intraperitoneal injection of ammonium acetate did not exceed that in intact animals. So the ammonia hyperproduction in the digestive tract could be the main contributing cause of fulminant hyperammonaemia in rats with thiopental coma and thus be involved into pathogenesis of the coma.
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Affiliation(s)
- Jury Ju Ivnitsky
- Military Toxicology and Medical Protection, Military Medical Academy, ul. Lebedeva 6, 194044 St. Petersburg, Russia
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Abstract
BACKGROUND For locally advanced rectal cancer surgery as sole treatment results in poor local control and survival. After adjuvant radiotherapy for locally advanced rectal cancer, small bowel toxicity has been the most frequent and serious side effect. The gain in survival and local control was accompanied by severe late chronic toxicity reducing the benefit of adjuvant treatment. REVIEW Clinical factors, pathology and treatment of late small bowel toxicity after adjuvant radiotherapy for locally advanced rectal cancer will be discussed. This review will focus on different surgical and radiotherapeutic means reducing the risk of late small bowel damage.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, Klinik und Poliklinik für Strahlentherapie der Universität Würzburg, Josef-Schneider-Strasse 11, 97080 Würzburg, Germany.
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33
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Calvo N, Iversen E, Munck LK. [Intestinal side effects of COX-2 inhibitors]. Ugeskr Laeger 2006; 168:1343-4. [PMID: 16579892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
COX-2 inhibitors and NSAIDs have similar analgesic, anti-inflammatory and severe upper intestinal side effects. Adding to the sparse and casuistic reports, a further five cases of severe lower intestinal illness associated with COX-2 inhibitor ingestion are presented. Diarrhoea due to microscopic colitis was associated with short-time ingestion of refecoxib and celecoxib by two patients. Refecoxib intake for two months was associated with spontaneous perforation of a well-functioning J-pouch in a patient with ulcerative colitis. Intake of celecoxib and etodolac was associated with colonic ulceration and stricture. Side effects related to COX-2 inhibitors are similar to those related to NSAIDs.
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Affiliation(s)
- Nadia Calvo
- Medicinsk Afdeling, Roskilde Amts Sygehus Køge, DK-4600 Køge.
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34
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Puri A, Agarwal AK, Garg S, Tyagi P, Sakhuja P. Diaphragm disease of the ileum: a case report. Trop Gastroenterol 2006; 27:46-7. [PMID: 16910062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Non-steroidal anti-inflammatory drugs induced diaphragm like lesions are a rare cause of small intestinal obstruction. They occur most commonly in elderly patients who have been consuming these drugs for prolonged periods for pain relief. We report the first case of ileal diaphragm disease from Asia. She responded well to localised resection of the diseased ileum. Intra-operative enteroscopy may be helpful in deciding the extent of intestinal resection.
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Affiliation(s)
- As Puri
- Department of Gastroenterology, GB Pant Hospital, New Delhi.
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Affiliation(s)
- K Honein
- Department of Gastroenterology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
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Abstract
Low-molecular-weight heparin (LMWH) is a safe and effective alternative to unfractionated heparin and coumadin in the treatment and prophylaxis of thrombosis in children. When compared with these more established anticoagulants, it is easier to achieve therapeutic levels and the incidence of hemorrhagic complications is equivalent or lower. In children there is less published experience than in adults, but the low frequency of significant bleeding appears to be similar. The authors describe a child on therapeutic doses of LMWH for a deep vein thrombosis who spontaneously developed an intramural hemorrhage in his small bowel, leading to infarction and a partial bowel resection.
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Affiliation(s)
- Peter H Shaw
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA. shawph@chpedu
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Abstract
We present a rare case of small bowel obstruction in a patient on long-term anticoagulation. A 53-year woman presented with abdominal pain and vomiting. She was on warfarin following aortic and mitral valve surgery. A small bowel follow through revealed jejunal narrowing consistent with a stricture. This probably was the result of submucosal bleeding because of over warfarinazation. The warfarin was stopped and she started on heparin with complete resolution of symptoms. This rare complication of anticoagulation should be considered in patients on warfarin. Early diagnosis is crucial as most patients are treated conservatively with very few patients requiring surgery.
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Affiliation(s)
- N Manu
- Royal Liverpool University Hospital, Liverpool, UK.
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38
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Usküdar O, Köksal D, Köksal AS. Partial intestinal obstruction due to clofazimine in a patient with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2005; 9:703-4. [PMID: 15971405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
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Abstract
Diaphragm-like stricture of the small bowel is an infrequent complication of the treatment of patients with nonsteroidal anti-inflammatory drugs (NSAIDs) and is part of the spectrum of diseases associated with NSAIDs injury. We report a patient with this condition who had used various forms of NSAIDs for over 20 years. Patient presented with abdominal pain and indigestion. Plain abdominal film revealed small bowel obstruction. Surgical resection of jejunum and proximal part of ileum identified dilated thickened hyperemic mucosa alternating with areas of small bowel fibrotic constriction. The mucosal surface showed multiple pink-tan mucosal folds (circumferential ridges) with focal hemorrhage and edema. Our findings support the local stimulation and damage and reparative process seen with NSAIDs use. A high degree of suspicion and awareness of diaphragm disease is necessary in those patients.
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Affiliation(s)
- Bihong Zhao
- Department of Surgical Pathology, University of Texas Medical Branch, Galveston, TX 77555-0588, USA
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40
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Chen JY, Wu GJ, Mok MS, Chou YH, Sun WZ, Chen PL, Chan WS, Yien HW, Wen YR. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients--a prospective, randomized, double-blind study. Acta Anaesthesiol Scand 2005; 49:546-51. [PMID: 15777304 DOI: 10.1111/j.1399-6576.2005.00674.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Postoperative ileus (PI) is the transient impairment of bowel motility due to surgical trauma and the associated physiological responses. Postoperative ileus results in patient discomfort, increases gastrointestinal risks, prolongs hospital stay and increases medical expenses. In this study, we investigated the effect of patient-controlled analgesia (PCA) morphine with or without ketorolac on bowel functions in patients after colorectal surgeries. METHODS A total of 79 patients who received elective colorectal resection were randomly allocated into two groups receiving either intravenous PCA morphine (M group) or intravenous PCA morphine plus ketorolac (K group). Recovery of bowel functions (bowel movement, passage of flatus, and soft diet intake), pain scores, morphine consumption, time for first ambulation, and opioid-related side-effects were recorded. RESULTS Patients in the K group received 29% less morphine than patients in the M group with comparable pain scores. The first bowel movement (1.5 [0.7-1.9] vs. 1.7 [1.0-2.8] days, P < 0.05) and the first ambulation (2.2 +/- 1.0 vs. 2.8 +/- 1.2 days, P < 0.05) were significantly earlier in the K group than in the M group. The time of the first flatus passing, the first intake of soft diet, and duration of hospital stay were not significantly different between the two groups. CONCLUSIONS The results of this study suggest that addition of ketorolac to intravenous morphine PCA provides an opioid-sparing effect but has limited benefit in shortening the duration of bowel immobility and time to first ambulation. These findings imply that postoperative ileus is attributable to multiple factors in addition to morphine consumption.
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Affiliation(s)
- J-Y Chen
- Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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41
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Solifenacin and darifenacin for overactive bladder. Med Lett Drugs Ther 2005; 47:23-4. [PMID: 15767976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Darifenacin (Enablex) and solifenacin (VESIcare) are 2 new oral anticholinergics available for once-daily symptomatic treatment of overactive bladder. Overactive bladder is a common condition in older patients. The 5 drugs currently approved for treatment are modestly effective but also cause anticholinergic adverse effects such as dry mouth and constipation and can cause confusion in the elderly. In some experimental studies, the new drugs particularly target bladder receptors, but the clinical significance of these findings is unknown.
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Abstract
PURPOSE OF REVIEW The small intestine is a more common site for nonsteroidal antiinflammatory drug (NSAID) toxicity than the well-recognized effects on the stomach and duodenum. Although NSAID strictures and perforation are rare, two thirds of regular NSAID users may be prone to small bowel enteropathy. This review highlights this emerging issue in patients requiring antiinflammatory drugs. RECENT FINDINGS NSAID enteropathy is a stepwise process involving direct mucosal toxicity, mitochondrial damage, breakdown of intercellular integrity, enterohepatic recirculation, and neutrophil activation by luminal contents, including bacteria. Unlike upper gastrointestinal toxicity, cyclooxygenase-mediated mechanisms are probably less important. Newer imaging modalities such as capsule endoscopy studies suggest that small bowel erosions may be common in nonselective NSAID users. Sulfasalazine and metronidazole may prove to be useful, therapeutic options for patients who cannot cease their NSAIDs. SUMMARY NSAID toxicity to the small intestine is common. Useful research tools have been developed to measure intestinal inflammation and permeability indirectly, but these are not generally available to the clinician, although enteroscopy and capsule endoscopy may be helpful. Anemia or hypoalbuminemia are useful clues to NSAID enteropathy. Cessation of the drug is ideal; otherwise, there is experimental data to support the use of sulfasalazine and metronidazole. Animal models are unraveling new mechanisms for mucosal toxicity beyond the cyclooxygenase model.
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Affiliation(s)
- J Krysa
- Department of General Surgery, Maidstone General Hospital, Maidstone, Kent.
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44
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Maiden LP, Bjarnason I. COX 2 inhibition and bowel strictures. Gut 2004; 53:1057-8. [PMID: 15194667 PMCID: PMC1774100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Pathak A, Debats P, Galinier M, Montastruc JL, Senard JM. Intestinal obstruction associated with oral midodrine. Clin Auton Res 2004; 14:202-3. [PMID: 15241651 DOI: 10.1007/s10286-004-0176-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 09/19/2003] [Indexed: 11/28/2022]
Abstract
We report a case of severe ileus possibly related to midodrine. To our knowledge, this case report is the first one suggesting an inhibitory effect of midodrine on intestinal motility. The potential pharmacological mechanisms leading to this adverse drug reaction are discussed below.
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Affiliation(s)
- Atul Pathak
- Service de Pharmacologie Clinique et Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Information sur le Médicament, Faculté de Médecine, Toulouse, France
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Burmeister BH, Schache D, Burmeister EA, Bell A, Poulsen MG, Walpole ET, Mackintosh J. Synchronous postoperative adjuvant chemoradiation therapy for locally advanced carcinoma of the rectum. Int J Colorectal Dis 2004; 19:55-9. [PMID: 12756591 DOI: 10.1007/s00384-003-0497-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The adjuvant management of locally advanced rectal cancer has been the subject of much debate over the past 10 years. Whilst it is now widely accepted that combined chemoradiation therapy is the treatment of choice for adjuvant therapy following resection of high-risk tumours, there is still no clear answer on the sequencing of the two modalities in the postoperative setting. PATIENTS AND METHODS Soon after the NCI in the United States issued its recommendations on the management of resected rectal cancer, we decided to commence a phase 2 study to collect data prospectively on the toxicity of postoperative combined chemoradiation therapy. Radiation therapy was given early in combination with bolus chemotherapy using 5-fluorouracil ( n=80). The prescribed radiation dose was 50.4 Gy in 28 fractions, and the chemotherapy was 450 mg/m(2) given with fractions 1 - 3 and 26 - 28. On completion of the radiation therapy the patient was given a further four cycles of bolus 5-fluorouracil at monthly intervals. The patients were then closely monitored for side effects from the therapy and for signs of local and distant relapse. RESULTS Acute toxicity of the therapy was significant, with 16% of patients experiencing severe bowel morbidity. The other major side effects of the therapy were skin reactions, neutropenia and bladder problems. Late bowel toxicity was also severe. The local in field relapse rate was 10%. The majority of relapses were at distant sites, mostly in the liver and lungs. The actuarial survival at 5 years was 55%. CONCLUSION We conclude that the combined adjuvant postoperative chemoradiation therapy using this protocol is effective but has significant acute and late morbidity. The optimum regimen for those patients requiring postoperative adjuvant therapy is yet to be determined.
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Affiliation(s)
- Bryan H Burmeister
- Princess Alexandra Hospital, University of Queensland, 4102, Woolloongabba, Queensland, Australia.
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Mir O, Dhote R, Scavennec R, Ropert S, Christoforov B. Cyclooxygenase 2 selective inhibitor induced bowel stricture: a case report. Gut 2004; 53:154. [PMID: 14684594 PMCID: PMC1773943 DOI: 10.1136/gut.53.1.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Belaiche J, Louis E. [Early obstructive colon after treatment of active refractory Crohn's disease with infliximab]. Gastroenterol Clin Biol 2003; 27:1045-7. [PMID: 14732856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Matsuo T, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Tokuda Y, Yoshida K. Treatment of persistent chylothorax with somatostatin. Ann Thorac Surg 2003; 76:340-1; author reply 341-2. [PMID: 12842586 DOI: 10.1016/s0003-4975(02)04397-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dudink J, Mearin LM, Sukhai RN. [Ileus after the use of loperamide in a child with acute diarrhea]. Ned Tijdschr Geneeskd 2003; 147:670-2. [PMID: 12712653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A 2-year-old girl was diagnosed as having acute gastroenteritis with severe diarrhoea, for which she was prescribed a loperamide solution. Following this she developed paralytic ileus. She was then treated conservatively and was administered fluid and electrolytes parenterally. She started to recover after 48 hours. In young children with acute diarrhoea there usually is no place for medicinal treatment, and certainly not with antimotility drugs such as loperamide.
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Affiliation(s)
- J Dudink
- Leids Universitair Medisch Centrum, afd. Kindergeneeskunde, Postbus 9600, 2300 RC Leiden.
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