Sodium polystyrene induced colonic perforation unmasked after flexible sigmoidoscopy
| Autor: | Judy Lin, Tsu-Hon Wang, Sita Chokhavatia, Robert S. Richards, Kenneth M. Klein |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Abdominal pain
medicine.medical_specialty Constipation Hepatology Exploratory laparotomy business.industry medicine.medical_treatment Perforation (oil well) Gastroenterology Sigmoid colon medicine.disease Pericardial effusion Surgery medicine.anatomical_structure Internal medicine medicine Abdomen medicine.symptom business Acute colitis |
| Zdroj: | The American Journal of Gastroenterology. 98:S150 |
| ISSN: | 0002-9270 |
| DOI: | 10.1016/s0002-9270(03)01211-5 |
| Popis: | 77 years old female with CAD, CVA, and polycystic kidney disease was admitted for 2 weeks of abdominal pain and 20 lb weight loss with anorexia over 6 months. Three weeks prior to this admission, she was given stool softeners for constipation. Subsequently, she had diarrhea and developed sharp left lower quadrant abdominal pain radiating to her back; associated with nausea and bilious vomiting. She also had 1 week of fevers up to 100°F which dissipated upon admission. Physical exam revealed normoactive bowel sounds and left lower quadrant tenderness without rebound or guarding. Lab data: hemoglobin 9.0 gm/dl, white count 9.2 k/cu mm, BUN 52 mg/dl and creatinine 2.6 mg/dl, bicarbonate 14 mmol/liter and lactate 0.5 mmol/liter. A CT scan of the abdomen revealed large tumor involving the sigmoid colon, sigmoid diverticula, polycystic kidneys, and small pericardial effusion. Empiric antibiotics (levofloxacin and metronidazole) were given. During hospitalization, she developed K+ 5.1 mg/dl for which she received a dose of oral sodium polystyrene (SPS). Flexible-sigmoidoscopy up to 35 cm from the anal verge revealed multiple diverticula and edematous and erythematous folds from 15 cm to 20 cm (biopsy showed acute colitis with focal non-necrotizing granulomas). Immediately post-sigmoidoscopy, she developed distended, tympanic abdomen and became tachycardic. An abdominal x-ray revealed free air and she underwent emergency exploratory laparotomy. The left colon was rock hard and the right colon was dusky with gross fecal soilage from cecal perforation. A right hemicolectomy was performed along with an abdominal wash out. Pathological examination revealed acute ischemic perforation of cecum with SPS crystals noted within the feces and in the perforation tract. She continued to deteriorate and expired one week later. |
| Databáze: | OpenAIRE |
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