[Acute intestinal ischemia after voluntary drug poisoning].
A case is reported of a patient who suffered from ischaemic enteritis after having taken an overdose of several drugs. The 42-year-old woman was found out no more than 7 h after she had taken a mixture of benzodiazepines, tricyclic antidepressants and barbiturates (4 mg.l-1 blood level on admission). She had been lying against a bedpost, resulting in compression of her anterior abdominal wall below the umbilicus, involving her right femoral nerve. There was a severe rhabdomyolysis. Despite clinical improvement, the patient being extubated the following day, her abdomen remained painful and swollen. A CT abdominal scan showed a peritoneal effusion and a distended small bowel. Laparatomy revealed severe ischaemia of the terminal 80 cm of ileum, with some gangrenous areas. This was resected, and a right-sided ileostomy performed. Histopathological examination demonstrated a mucosal necrosis without mesenteric arterial thrombosis. A bilateral pleural effusion occurred during postoperative course, requiring drainage. Thereafter, the clinical course was uneventful, with intestinal continuity being re-established three months later. The femoral paralysis receded spontaneously. It is likely that this unusual postural complication of coma may be attributed to a transient compression of mesenteric vessels.
Service d'Anesthésie-Réanimation, Centre Hospitalier Lyon-Sud, Pierre-Bénite.
F
F
Bernard
J P
JP
Perdrix
A
A
Lepape
J M
JM
Grozel
J L
JL
Caillot
D000208:Acute Disease; D000328:Adult; D014151:Anti-Anxiety Agents / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D001463:Barbiturates / Q000506:poisoning*; D001569:Benzodiazepines; D003128:Coma / Q000139:chemically induced / Q000150:complications*; D004347:Drug Interactions; D005260:Female; D005267:Femoral Nerve / Q000293:injuries; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology* / Q000503:physiopathology; D009408:Nerve Compression Syndromes / Q000209:etiology; D011187:Posture; D012206:Rhabdomyolysis / Q000209:etiology
D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D001463:Barbiturates; D001569:Benzodiazepines
Ischémie intestinale aiguë dans les suites d'une intoxication médicamenteuse volontaire.