1. Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon.
- Author
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Zhang ZM, Lin XC, Ma L, Jin AQ, Lin FC, Liu Z, Liu LM, Zhang C, Zhang N, Huo LJ, Jiang XL, Kang F, Qin HJ, Li QY, Yu HW, Deng H, Zhu MW, Liu ZX, Wan BJ, Yang HY, Liao JH, Luo X, Li YW, Wei WP, Song MM, Zhao Y, Shi XY, and Lu ZH
- Subjects
- Abdominal Pain etiology, Abdominal Pain therapy, Anti-Bacterial Agents therapeutic use, Biopsy, Colectomy methods, Colon, Sigmoid diagnostic imaging, Colon, Sigmoid pathology, Colon, Sigmoid surgery, Colonography, Computed Tomographic, Colonoscopy instrumentation, Colonoscopy methods, Constipation etiology, Constriction, Pathologic chemically induced, Constriction, Pathologic complications, Constriction, Pathologic therapy, Contrast Media administration & dosage, Diagnosis, Differential, Diarrhea etiology, Diarrhea microbiology, Diatrizoate Meglumine administration & dosage, Dilatation methods, Female, Fluid Therapy, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy, Humans, Intestinal Obstruction chemically induced, Intestinal Obstruction complications, Intestinal Obstruction therapy, Laparoscopy methods, Levofloxacin therapeutic use, Middle Aged, Self Expandable Metallic Stents, Colon, Sigmoid drug effects, Constriction, Pathologic diagnosis, Diarrhea diagnosis, Drugs, Chinese Herbal adverse effects, Inflammatory Bowel Diseases diagnosis, Intestinal Obstruction diagnosis, Pityriasis Rosea drug therapy
- Abstract
A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of drug-induced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids., Competing Interests: Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
- Published
- 2017
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