Acute Perforation of Colonic Diverticula Associated With Short-Term Indomethacin

Coutrot, S; Roland, Dominique; Barbier, J; Marcq, P. Van Der; Alcalay, M; Matuchansky, C

doi:10.1016/s0140-6736(78)92385-1

Cited by 68 publications

(18 citation statements)

References 7 publications

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“…The most severe lesions were found in the large bowel, with two ulcers, in the left flexure and in the sigmoid, causing a large subphrenic abscess and a cool-vaginal fistula, respectively. These lesions are often difficult to diagnose both on colonoscopy and on barium enema (27); This fact could explain why several cases of NSAID-induced colitis were diagnosed only when the lesions were advanced and caused severe bleeding or septic complications (28)(29)(30). Other authors have described internal pelvic fistulas developing in the colon of patients taking various NSAIDs (31), as in Patient 1.…”

Section: Discussionmentioning

confidence: 99%

Multiple Enterocolic Perforations and Their Possible Association with Prolonged Intake of Nimesulide: Report of Two Cases

et al. 2005

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KEY WORDS: enterocolic perforations; nonsteroidal anti-inflammatory drugs; adverse side effects; nimesulide.Nimesulide is a selective cyclooxygenase type 2 (COX-2) inhibitor that, although having the characteristic antiinflammatory effects of nonsteroidal anti-inflammatory drugs (NSAIDs), has better gastrointestinal tolerability (with less gastric and duodenal injury) than conventional nonselective cyclooxygenase inhibitors) (1). It is well known that toxicity in chronic NSAIDs users is not specific to the gastroduodenal tract. Over the past few years several reports have focused on the prevalence, clinical aspects, and pathogenesis of NSAIDs-induced adverse side effects (ASEs) on the small and large intestine, including diaphragm-like strictures, ulcerations, and perforations, associated with blood and protein loss (2-5).The prevalence of NSAID-associated enteropathy in the upper gastroenteric tract (UGT) is approximately 20%, and among patients chronically taking NSAIDs the incidence of severe bleeding or perforation complications is 1 to 2% per year of use (6). Nevertheless, the assumption that enteropathy is mainly located in the UGT may be considered a bias, as demonstrated by retrospective, hospital-based, systemic studies showing that ASEs may sometimes have a higher prevalence in the lower gastroenteric tract (LGT) than in the UGT (7). Furthermore, a threeto-one ratio of large-versus-small bowel injuries (ulcers or perforations) was found (8).However, these intestinal complications were not reported in patients on nimesulide. A clinical survey carried out on a large population taking nimesulide gave no ev-

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Section: Discussionmentioning

confidence: 99%

Multiple Enterocolic Perforations and Their Possible Association with Prolonged Intake of Nimesulide: Report of Two Cases

et al. 2005

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“…Previous publications suggest that inhibition of PG synthesis may be detrimental to diseased human colorectal mucosa [2][3][4][5] and that PGs may protect against Cl. difficile-induced colitis in the hamster [14] and against ethanol-mediated colonic damage in the rat [15].…”

Section: Discussionmentioning

confidence: 99%

“…Prostaglandins (PGs) prevent this effect, as well as the damage produced by other noxious agents, and thus appear to play a cytoprotective role in the stomach and small intestine [1]. Although various inhibitors of PG synthesis may initiate or exacerbate inflammatory change in already diseased human large intestine [2][3][4][5], and indomethacin suppositories produce irritation, bleeding and tenesmus in 10-30% of rheumatoid patients [6][7][8], there is no information about the functional consequences of drug-induced PG deficiency in previously uninflamed human colorectal mucosa.…”

Section: Introductionmentioning

confidence: 99%

Are prostaglandins cytoprotective in the human large intestine?—the effect of indomethacin on rectal mucosal function and prostaglandin E2 releasein vivo

Rampton

Barton

1984

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To test the hypothesis that prostaglandins are cytoprotective in the human large intestine, we investigated the effect of withdrawal of treatment with indomethacin suppositories on bowel habit and on rectal mucosal electrolyte transport and prostaglandin production in 8 patients taking such treatment for rheumatological disorders. Discontinuation of indomethacin doubled rectal mucosal prostaglandin E2 release (p less than 0.05) measured by in vivo rectal dialysis. Although there was no significant overall change in stool frequency, stool consistency, rectal bleeding or sodium absorption (also assessed by rectal dialysis), sigmoidoscopic appearance (p = 0.05), rectal mucosal potential difference (p less than 0.05) and potassium transport (p = 0.01) each reverted towards normal on indomethacin withdrawal. These results accord with the theory that, as in the upper gastrointestinal tract, prostaglandins may play a role in the maintenance of rectal mucosal structure and function.

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“…Die Begleittherapie mit Kortikosteroiden und anderen Immunsuppressiva ist ebenso mit einem erhöhten Perforationsrisiko verbunden [59,62,66,[71][72][73]. Hier wird als Ursache postuliert, dass eine Mikroperforation durch die Immunsuppression nicht eingedämmt werden kann und dadurch eine erhöhte Gefahr für Abszessbildung und Makroperforation besteht [65].…”

Section: Klinisches Erscheinungsbild Einer Divertikelerkrankungunclassified

Möglichkeiten und Grenzen der ambulanten Therapie der Divertikelkrankheit

Helwig¹

2012

Viszeralmedizin

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Acute Perforation of Colonic Diverticula Associated With Short-Term Indomethacin

Cited by 68 publications

References 7 publications

Multiple Enterocolic Perforations and Their Possible Association with Prolonged Intake of Nimesulide: Report of Two Cases

Multiple Enterocolic Perforations and Their Possible Association with Prolonged Intake of Nimesulide: Report of Two Cases

Are prostaglandins cytoprotective in the human large intestine?—the effect of indomethacin on rectal mucosal function and prostaglandin E2 releasein vivo

Möglichkeiten und Grenzen der ambulanten Therapie der Divertikelkrankheit

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