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Non-occlusive mesenteric ischemia induced by a polyethylene glycol with ascorbate-based colonic bowel preparation

  • Rindo Ishii
  • Eiji Sakai
  • Kentarou Nakajima
  • Nobuyuki Matsuhashi
  • Ken OhataEmail author
Case Report
  • 66 Downloads

Abstract

Although conventional bowel preparation for colonoscopy rarely causes serious complications, such complications can be fatal and, therefore, require early recognition and prompt treatment. Herein, we report a case of non-occlusive mesenteric ischemia (NOMI) induced by polyethylene glycol with an ascorbate component (PEG + Asc) that was used as a colonic bowel preparation. An- 82-year-old woman with a medical history of hypertension, atrial fibrillation and mild chronic renal failure received a cancer screening colonoscopy. Four hours after the administration of PEG + Asc, she vomited and gradually developed abdominal distention. She went into hypovolemic shock, and a CT scan revealed a distal colon obstruction caused by fecal material. A colonoscopy identified focal necrotic mucosa between the rectum and descending colon, suggesting the occurrence of irreversible intestinal necrosis; consequently, she underwent emergency surgery. The operative and pathological findings showed a discontinuous area of necrosis from the anal margin to the ileum without thrombotic change in the main mesenteric arteries, consistent with a diagnosis of NOMI. NOMI is a rare but fatal disease that can advance to an irreversible stage before a definite diagnosis can be made. Since PEG + Asc is a hypertonic laxative solution, the possibility that dehydration might cause severe secondary complications must be considered.

Keywords

Non-occlusive mesenteric ischemia (NOMI) Colonoscopy Ascorbate component Bowel preparation 

Notes

Compliance with ethical standards

Conflict of interest

Rindo Ishii, Ken Ohata and Eiji Sakai, Kentarou and Nakajima and Nobuyuki Matsuhashi declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Rindo Ishii
    • 1
  • Eiji Sakai
    • 1
  • Kentarou Nakajima
    • 2
  • Nobuyuki Matsuhashi
    • 1
  • Ken Ohata
    • 1
    Email author
  1. 1.Department of GastroenterologyNTT Medical Center TokyoTokyoJapan
  2. 2.Department of SurgeryNTT Medical Center TokyoTokyoJapan

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