Ischemic colitis (IC) is a rare adverse effect of antipsychotic medications and is most commonly associated with the phenothiazine class of neuroleptics. Different cases reported in patients without other obvious risk factors led to the link between taking neuroleptics and acute ischemic colitis. The severe form is acute necrotizing colitis. This entity is characterized by sudden onset of abdominal pain and bloody diarrhea, progressing rapidly to produce severe illness with general peritonitis and shock.
We report a case of a 26 years old Moroccan man, treated for four years for chronic psychosis, admitted to the emergency for abdominal pain and diarrhea. Clinical examination showed a conscious patient, tachycardia at 120 beats/min, febrile to 38.5 ° C, with generalized abdominal defense. Laboratory tests revealed: GB 33400, CRP 290 mg/l, abdominal tomography revealed colonic distension. The patient was prepared and admitted to the operating room. During the intervention, a colonoscopy was performed and shown ulcerated lesions with a purplish background without interval healthy mucosa. A subtotal colectomy with ileostomy and sigmoidostomy were performed. The histological examination of the surgical specimen showed superficial and extended ulcerations without interval healthy mucosa. Thus, no factors for IC were detected by appropriate workup other than the long-time use of neuroleptics. The restoration of continuity by ileorectal anastomosis was achieved two months later with a good clinical outcome, and the patient was recommended for psychiatry to reevaluate his antipsychotic regimen given the association with IC.
Our case supports that neuroleptics can promote IC in patients under antipsychotic medications. It should alert physicians who prescribe neuroleptics and colorectal surgeons to the possibility of intestinal ischemia. Although the clinical presentation is non-specific, abdominal pain and distension should be headed, and endoscopy carried out. A better knowledge of this condition should promote earlier diagnosis and improve management.
Peyrière H, Roux C, Ferard C, Deleau N, Kreft-Jais C, Hillaire-Buys D, et al. Antipsychotics-induced ischaemic colitis and gastrointestinal necrosis: areview of the French pharmacovigilance database. Pharmaco epidemiol Drug Saf. 2009 Oct;18(10):948-55. https://doi.org/10.1002/pds.1801
Moszkowicz D, Mariani A, Trésallet C, Menegaux F. Ischemiccolitis:The ABCs of diagnosis and surgicalmanagement. J Visc Surg. 2013 Feb;150(1):19-28. https://doi.org/10.1016/j.jviscsurg.2013.01.002
Upala S, Wijarnpreecha K, JaruvongvanichV, Bischof E, Sanguankeo A. Antipsychotics-induced ischemic colitis. Am J EmergMed. 2015Nov;33(11):1716.e5-6. https://doi.org/10.1016/j.ajem.2015.03.038
González ES, Jaime FCD, Martínez MTB, Antoñana ADV, Cortés JAO. Olanzapine-induced ischemic colitis.Rev EspEnferm Dig. 2016 Aug;108(8):507-9. https://doi.org/10.17235/reed.2015.3856/2015
Rodrigues A, Duarte A, Marques A, Magalhães M,Camarneiro R, Silva R, Ferreira Á, and all. Multiple spontaneous small bowel perforations due to clozapine-Case report. Int J Surg Case Rep. 2018;53:262-264. https://doi.org/10.1016/j.ijscr.2018.10.067
Peyro Saint Paul L, Mosquet B, I. Hourmand-Ollivier D, Perroux R, Morello C. Roberge.Ischemic colitis in psychiatry. GastroenterolClin Biol. Jun-Jul2008;32(6-7):578-80. https://doi.org/10.1016/j.gcb.2008.02.001
Colombat M, Carton S, Bakhache B. Ischemic colitisand neuroleptics. Rev Med Interne.1999 Apr;20(4):373-4. https://doi.org/10.1016/s0248-8663(99)83082-3
Hochain P. Colite ischémique. EMC (Elsevier Masson SAS, Paris). Gastro-entérologie2002 [9-073-A-10].
Abdalla S, Brouquet A, Lazure T, Costaglioli BPenna, C, Benoist S. Outcome of emergency surgeryfor severe neuroleptic-induced colitis: results of aprospective cohort. Colorectal Dis. 2016 Dec;18(12):1179-1185. https://doi.org/10.1111/codi.13376
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