PP 115. Ischaemic Colitis as a Rare Complication of Chronic NSAIDS Use.
N. Samuel, V. Proctor, K. Siddique, L. Wheldon, M. Hanif Shiwani
17:30 - 17:36h
at Margrit Room
Categories: Emergency Surgery, Poster Session
Session: Poster II (P3) - Emergency / Thoracic Surgery
Background
Nonsteroidal anti-inflammatory drugs(NSAIDs) are one of the most commonly used drugs and gastroduodenal toxicity is a well-known complication of its chronic use. We report a rare case of ischaemic colitis secondary to chronic NSAID ingestion.
Material and Methods
Case Presentation: A 67-year-old woman presented with two day history of abdominal pain, distension, vomiting and not opening bowels. She was tachycardic, hypotensive and hypoxic with a worsening acidosis and raised lactate despite aggressive fluid resuscitation; CT abdomen demonstrated ischaemia of terminal ileal segment, distal transverse and descending colon. She
underwent emergency small bowel resection and subtotal colectomy with formation of endileostomy. Histology of the resected specimen was reported as patchy areas of submucosal necrosis and fibrous thickening consistent with ischaemia, possibly related to NSAID use. On revisiting history, patient admitted to regular NSAIDs use for chronic pain.
Result
Discussion: GI mucosa uses COX-1 to generate mucosal-protective prostaglandins(PGs). MostNSAIDs cause reversible inhibition of COX-enzymes and with prolonged use cause injuries ranging from subtle alteration in mucosal barrier function to macroscopically obvious ulcers, which is commonly found in the acidic environment of gastro-duodenum. Although ischaemic colitis is not a stated adverse effect of NSAIDs, chronic use in this patient had caused extensive ulceration unusually at the distal gut leading to secondary ischaemia.
Conclusion
Although NSAIDs are unlikely to be implicated in most cases of ischaemic colitis, it could be considered as one of the differentials, especially in the elderly with a history of its chronic use.
