Opiate withdrawal syndrome mimicking postoperative intestinal obstruction.
Patients with complicated inflammatory bowel disease commonly undergo repeated surgical procedures, often against a background of chronic opiate use. We describe a case in which a postoperative attempt to withdraw opiate analgesia on two separate occasions led to a clinical syndrome strongly suggestive of intestinal obstruction, the signs and symptoms of which settled rapidly on re-introduction of opiates. Small bowel contrast studies indicated a level of obstruction which not only fluctuated, but occurred at an unusual site for mechanical obstruction. In patients with a history of long-standing opiate use, postoperative opiate withdrawal can cause a significant, functional bowel disorder and should be borne in mind in the differential diagnosis of postoperative intestinal obstruction. Patients can be treated effectively with clonidine.
Department of Surgery, Hope Hospital, Salford M6 8HD, UK.
C
C
Macutkiewicz
S
S
Anwar
C
C
Babbs
H
H
Burnett
G L
GL
Carlson
D000328:Adult; D003108:Colonic Diseases / Q000150:complications* / Q000601:surgery; D017577:Cutaneous Fistula / Q000150:complications* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications*; D013375:Substance Withdrawal Syndrome / Q000150:complications*