title: [Megacolon during treatment with lactulose].
abstract: Two female patients aged 88 and 82 who were being treated for constipation with lactulose, developed life-threatening dilatation of the bowel. Both underwent surgery. One of them was found to have cancer of the bowel; she had an uneventful postoperative recovery. No mechanical abnormalities were found in the second patient but she died due to respiratory insufficiency following aspiration. Lactulose is one of the most frequently prescribed laxatives. In the colon it is metabolized by bacteria into short-chain fatty acids, hydrogen and carbon dioxide. The resulting production of gas in the colon can contribute to a non-toxic megacolon, particularly in patients with delayed intestinal passage.
authors.affiliation: Afd. Inwendige Geneeskunde, VU Medisch Centrum, De Boelelaan 1117, 1081 HV Amsterdam. jj.vandervliet@vumc.nl
authors.forename: H J
authors.initials: HJ
authors.lastname: van der Vliet
authors.forename: A A
authors.initials: AA
authors.lastname: van Bodegraven
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000378:metabolism; D003106:Colon / Q000378:metabolism* / Q000382:microbiology; D003110:Colonic Neoplasms / Q000150:complications; D003248:Constipation / Q000188:drug therapy; D017809:Fatal Outcome; D005232:Fatty Acids, Volatile / Q000378:metabolism; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D006859:Hydrogen / Q000378:metabolism; D007792:Lactulose / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D008531:Megacolon / Q000209:etiology* / Q000601:surgery; D011015:Pneumonia, Aspiration / Q000150:complications; D011183:Postoperative Complications; D012131:Respiratory Insufficiency / Q000209:etiology
chemical_list: D005232:Fatty Acids, Volatile; D005765:Gastrointestinal Agents; D002245:Carbon Dioxide; D007792:Lactulose; D006859:Hydrogen