ABSTRACT
BACKGROUND: Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death. OBJECTIVE: Present a case of a colonic pseudo-obstruction in a patient with polypharmacy as the only risk factor and to review the medical literature related to the treatment of this pathology. CLINICAL CASE: The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully. CONCLUSION: It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.
Subject(s)
Abdomen, Acute/etiology , Colonic Pseudo-Obstruction/chemically induced , Gastrointestinal Motility/drug effects , Intestinal Perforation/etiology , Aged , Anastomosis, Surgical/methods , Antihypertensive Agents/adverse effects , Antihypertensive Agents/therapeutic use , Atorvastatin/adverse effects , Atorvastatin/therapeutic use , Cholinergic Antagonists/adverse effects , Cholinergic Antagonists/pharmacology , Cholinergic Antagonists/therapeutic use , Colon/surgery , Colon, Sigmoid/surgery , Colonic Pseudo-Obstruction/physiopathology , Colonic Pseudo-Obstruction/surgery , Drug Synergism , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Ileum/surgery , Intestinal Perforation/surgery , Ketoconazole/therapeutic use , Levetiracetam , Meropenem , Nifedipine/adverse effects , Nifedipine/pharmacology , Nifedipine/therapeutic use , Peritonitis/drug therapy , Peritonitis/etiology , Piracetam/adverse effects , Piracetam/analogs & derivatives , Piracetam/therapeutic use , Polypharmacy , Quetiapine Fumarate/adverse effects , Quetiapine Fumarate/therapeutic use , Raloxifene Hydrochloride/adverse effects , Raloxifene Hydrochloride/therapeutic use , Respiration, Artificial , Risk Factors , Thienamycins/therapeutic useABSTRACT
Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial to improve outcomes.
