Poisoning-related bowel infarction: Characteristics and outcomes

Abstract

Background. Bowel infarction (BI) is a rare complication of poisoning. We aimed to describe the characteristics of BI in poisoned patients compared to nonpoisoned patients. Methods. A retrospective review over a 4-year period of patients hospitalized in an intensive care unit who were diagnosed with BI; Mann–Whitney and Fischer's exact tests were used for comparisons. Results. Seventeen patients with BI [11 F/6 M, 66-year olds (55–72), median (25–75% percentiles)], including five out of around 1,800 poisoned patients, were identified (toxicants: nicardipine + venlafaxine, amlodipine, propranolol + hydroxyzine, dextropropoxyphene + clomipramine, and turpentine). Clinical presentation and severity were comparable between both groups. However, poisoned patients were significantly younger (p = 0.03) with less cardiovascular disease (p = 0.04) and fewer risk factors (p = 0.008). Delayed BI occurred 48 h (36–60) after the start of vasopressor administration [15.5 mg/h (4.5–30.0) norepinephrine and 6.0 mg/h (4.9–6.3) epinephrine]. Typical poisoning-related injury was jejunal ischemia without ileal localization. The predominant mechanism was nonocclusive mesenteric ischemia. Mortality was lower in poisoned patients (20 vs. 90%, p = 0.009). Conclusion. Physicians should be aware that, despite patient age and the lack of cardiovascular risk factors, BI may rarely complicate severe poisonings requiring elevated doses of vasopressors and may present in a delayed fashion.

Keywords:

• Bowel infarction
• Mesenteric ischemia
• Poisoning
• Vasopressor
• Cardiovascular failure
• Drug adverse effect

Acknowledgment

The authors thank Jenny Lu, MD, from Toxikon Consortium, Chicago, USA, for her helpful review of this manuscript.