Abstract
PURPOSE: This report stresses the importance of local complications caused by ergotamine abuse for the treatment of migraine headaches. METHODS: We present an unusual case of a complex rectovaginal fistula (RVF) caused by long-term ergotamine suppository abuse. RESULTS: A 39-year-old female was referred after she had undergone a transverse colostomy for temporary fecal diversion. Evaluation, including proctoscopy, gastrograffin enema, vaginogram, and pelvic computerized tomography revealed a RVF 6 cm proximal to the dentate line with distal rectal stricture. Surgical intervention included take down of the transverse colostomy with reanastomosis, proctectomy with excision of the fistula, creation of a colonic “J-pouch” with a coloanal anastomosis, and construction of a temporary loop ileostomy. The patient had an uneventful recovery, and her ileostomy was closed three months later. Pathologic examination of the surgical specimen failed to reveal any specific etiology of the RVF. However, her ten-year use of up to five ergotamine suppositories per day for migraine treatment is associated with a local ischemic effect. Pathophysiology of this rare cause of RVF and the surgical procedure are discussed. CONCLUSION: If evidence of any side effects of ergotamine suppositories is seen, early discontinuation of the drug should be considered to avoid complications such as RVF and/or strictures.
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References
Shpilberg O, Ehrenfeld M, Abramowich D, Samra Y, Bat L. Ergotamine-induced solitary rectal ulcer. Postgrad Med J 1990;66:483–5.
Eckardt VF, Kanzler G, Remmele W. Anorectal ergotism: another cause of solitary rectal ulcers. Gastroenterology 1986;91:1123–7.
Schaarschmidt K, Richter HJ, Gross E, Eigler FW. Ergotaminbedingte Analulcera. Chirurg 1984;55:584–8.
Ontyd J, Erckenbrecht JF, Berges W. Rektumstenosen bei langzeittherapie mit ergotamin. Deutsone Medizinische Wochenschift 1989;114:1702–5.
Baptista AP, Mariano A, Machado A. Perianal ulcers caused by ergotamine- containing suppositories. Acta Med Port 1992;5:39–41.
Wörmann B, Höchter W, Seib HJ, Ottenjann R. Ergotamine-induced colitis. Endoscopy 1985;17:165–6.
Jost WH, Raulf F, Müller-Lobeck H. Anorectal ergotism induced by migraine therapy. Acta Neurol Scand 1991;84:73–4.
Wienert V, Grussendorf EJ. Anokutamer ergotismus gangraenosus. Hautarzt 1980;31:784–5.
Orton DA, Richardson RJ. Ergotamine absorption and toxicity. Postgrad Med J 1982;58:6–11.
Graham AN, Johnson ES, Persaud NP, Turner P, Wilkinson M. Ergotamine toxicity and serum concentrations of ergotamine in migraine patients. Hum Toxicol 1984;3:193–9.
Machnig T, May A, Steininger H, Streitberg U, Hahn E, Ell C. Ergotamin-induzierte rektumstenose bei einer patientin mit langjähriger migräne. Leber Magen Darm 1993;23:166–8.
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Pfeifer, J., Reissman, P. & Wexner, S.D. Ergotamine-induced complex rectovaginal fistula. Dis Colon Rectum 38, 1224–1226 (1995). https://doi.org/10.1007/BF02048343
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DOI: https://doi.org/10.1007/BF02048343