Nault JC, Mégarbane B, Théodore J, Deye N, Nemeth J, Valleur P, Baud FJ
Poisoning-related bowel infarction: Characteristics and outcomes. [Journal Article]
Clin Toxicol (Phila) 2009 May; 47(5):412-8.
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.
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