An alternative path to the cecum: nicorandil-associated diverticular sigmoido-cecal fistula

Ramos, Graciela L.; Coimbra, João; Barreiras, João; Marques, Ana Rita

doi:10.1055/s-0030-1256006

Cited by 3 publications

(5 citation statements)

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“…Ramos et al emphasized a possible impact (side effect) of nicorandil, a potassium channel opener with a nitrate component used in the management of angina, in the pathogenesis of diverticular sigmoido-cecal fistula [12]. On the other hand, Chung et al suggested that the presence of a sigmoidocecal fistula in complicated diverticular disease might result in obstruction but in a different way than we have described.…”

Section: Discussionmentioning

confidence: 63%

“…Sanowski and Costello described for the first time a case of sigmoido-cecal fistula as an unusual complication of acute diverticulitis [9]. In a review of the literature, we found only 4 cases of sigmoido-cecal fistulas [9–12], and an additional case which was malignant [13]. Almost all of the aforementioned reports referred to specific aspects of this rare complication.…”

Section: Discussionmentioning

confidence: 99%

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Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature

et al. 2018

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Patient: Female, 76Final Diagnosis: Complicated recurrent diverticulitisSymptoms: Abdominal pain • bloating • inability to pass stool and gasMedication: —Clinical Procedure: Hartmann’s procedureSpecialty: SurgeryObjective:Unusual clinical courseBackground:Although diverticular disease is well described and treated in daily clinical practice, there are cases that attract great interest because of their complexity and difficulty in management. Herein, we describe a rare case of colo-colonic fistula-complicated diverticulitis that necessitated urgent surgical intervention.Case Report:A 76-year-old female patient with a known history of diverticular disease of the sigmoid colon presented in the Emergency Department for evaluation of left lower quadrant abdominal pain. The clinical and radiological examinations revealed a recurrent episode of acute diverticulitis of the sigmoid colon. However, it was of great interest that we detected a sigmoido-cecal fistula in the abdominal computed tomography (CT). The patient was admitted to the hospital for conservative treatment. After 48 hours, the patient’s clinical status deteriorated, with pain aggravation, abdominal distension, bloating, and metallic bowel sounds. The simple abdominal x-ray revealed large-bowel obstruction and the CT demonstrated worsening inflammation of the sigmoid colon. An exploratory laparotomy revealed an inflamed dolichol-sigmoid colon forming a fistulous tract with the cecum and thus, mimicking a closed loop obstruction. The sigmoid colon was transected en bloc with the sigmoido-cecal fistula and a Hartmann’s procedure was performed.Conclusions:This case is extremely unusual as the patient presented at the same time two complications of diverticular disease, both obstruction and this rare formation of sigmoido-cecal fistula. It is presented in order to acquaint surgeons with the possibility of an unexpected course of this disease which indeed necessitates an individualized management.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature

et al. 2018

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“…In the other four cases, patients experienced peristomal ulcers, which sometimes persisted, and their history revealed colovaginal (2), colovesical (1) and vesicocolic (1) FIAO leading to a possible retrospective diagnosis of nicorandil‐induced FIAO (17,18). It is worth noting that in two patients (15,16) symptoms before FIAO diagnosis were poor. But in one patient (14) persistent perianal fistula might have drawn attention, and in two patients with retrospective diagnosis (17), a concomitant ulceration was associated with the development of FIAO.…”

Section: Nicorandil and Fistula Into Adjacent Organsmentioning

confidence: 97%

“…To date, eight cases of nicorandil-induced FIAO have been described (Table 1). Four cases had an orocutaneous (1), orolabial (1), rectovaginal (1) or sigmoidocaecal (1) location (13)(14)(15)(16). In the other four cases, patients experienced peristomal ulcers, which sometimes persisted, and their history revealed colovaginal (2), colovesical (1) and vesicocolic (1) FIAO leading to a possible retrospective diagnosis of nicorandil-induced FIAO (17,18).…”

Section: Nicorandil and Fistula Into Adjacent Organsmentioning

confidence: 99%

Nicorandil: from ulcer to fistula into adjacent organs

Tréchot¹,

Petitpain²,

Guy³

et al. 2012

International Wound Journal

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Nicorandil is an original vasodilatator used to control angina by decreasing cardiac preload and afterload. Since 1997, many reports of single or multiple nicorandil-induced ulcerations have been published. To date, eight cases of nicorandil-induced fistula into adjacent organs have been described. The pathogeneses of nicorandil-induced ulceration and fistula into adjacent organs are not yet elucidated. The two main hepatic biotransformation pathways of nicorandil are denitration and reduction of the alkyl chain leading to nicotinamide and niconitic acid which merge into the endogenous pool of nicotinamide adenine dinucleotide/phosphate. This merging which is known as saturable, may contribute to a slow and abnormal distribution of nicotinamide and nicotinic acid out of the endogenous pool. Under these special conditions, providing these two molecules in situ, nicotinic acid associated with nicotinamide may ulcerate rather recent or maintained trauma. Ulcers and fistulae induced by nicorandil heal after withdrawal. Surgical intervention is unnecessary and inappropriate as it is ineffective and exacerbates morbidity. All practitioners should be correctly informed about these serious but preventable nicorandil side effects, which mostly occur in the elderly and fragile population. In the absence of corrective measures, withdrawal of this original and active drug should be considered.

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“…Histology was not suggestive of inflammatory bowel disease or mesenteric ischaemia. Ramos et al [106] gave notice of a sigmoido-caecal fistula in a 76-year-old man on nicorandil, who suffered from a 6-month history of diarrhoea; again, no element was found to suggest a neoplastic or inflammatory origin. The WHO list features one case of caecum perforation (0.1%), flagged in the UK and resulting in a life-threatening but not fatal event.…”

Section: Nos "Intestinal Ulcerations" (13%)mentioning

confidence: 99%

Nicorandil, Gastrointestinal Adverse Drug Reactions and Ulcerations: A Systematic Review

et al. 2016

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An alternative path to the cecum: nicorandil-associated diverticular sigmoido-cecal fistula

Cited by 3 publications

References 4 publications

Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature

Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature

Nicorandil: from ulcer to fistula into adjacent organs

Nicorandil, Gastrointestinal Adverse Drug Reactions and Ulcerations: A Systematic Review

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