Polysorbate 80 and Low-Osmolality Water-Soluble Contrast Medium Enema in Diagnosis and Treatment of Faecal Obstruction in Malignant Phaeochromocytoma

Abstract

Stercoral obstruction in a young woman with disseminated phaeochromocytoma was diagnosed and treated successfully using an enema of isosmolar iohexol (Omnipaque) and 1% polysorbate 80 (Tween 80) without complication. Surgical intervention was thus avoided. A low osmolality water-soluble contrast medium (iohexol 150 mg I/ml) with a wetting agent (1% Tween 80) was used because a barium suspension would have inspissated, exacerbating the constipation and a hyperosmolar contrast medium might have precipitated a hypertensive crisis and destabilized her critical salt and water balance.

Malignant pheochromocytoma associated with pseudo-obstruction of the colon

“…This aim was achieved, but the patient was unable to evacuate a large amount of feces. Ratcliffe,8 believing that the formation of stool lumps in the large intestine obstructed the intestinal passage, attempted to relieve ileus by administering an enema containing a strong surfactant, polysorbate 80. This treatment was effective, and a large amount of stool was evacuated.…”

“…2,3 In malignant cases, however, the treatment of intestinal symptoms is challenging because it is difficult to control the levels of catecholamines secreted from the metastatic foci of the tumor mass. [4][5][6][7][8][9][10] We report a case of malignant pheochromocytoma complicated by severe intestinal pseudo-obstruction in a patient in whom conservative treatment failed but surgical intervention was effective.…”

Letters to the Editor

“…Low osmolality water soluble (LOWS) contrast media isotonic, almost, isotonic with plasma have iodine concentrations of 180-200 mgm I/ml. These solutions are certainly sufficiently opaque for oesophageal examination in most patientscertainly most paediatric patients including an obese 16 year old (Ratcliffe 1985) and sufficiently opaque for an enema in qn adult (Ratcliffe 1986).…”

“…I can assure readers that I have accidentally flooded the lungs of at least 5 more babies and children with large but unmeasured volumes of isomolar LOWS contrast media since I reported doing this in 7 patients in 1986 (Ratcliffe 1986), and none of the 12 has suffered any ill effects in the medium term, but two were a bit distressed at the time. However I am still cautious about LOWS contrast media in the lungs because of the reports showing histologic reaction to metrizamide isotonic with plasma (McAlister andAskin 1982, andAlford et a1 1983).…”