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.
Macutkiewicz
C
C
Department of Surgery, Hope Hospital, Salford M6 8HD, UK.
Anwar
S
S
Babbs
C
C
Burnett
H
H
Carlson
G L
GL
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*