Poisoning-related bowel infarction: characteristics and outcomes.
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).


CONCLUSIONS
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.
Nault
Jean-Charles
JC
Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Réanimation Médicale et Toxicologique, Université Paris - Diderot, Paris, France.
Mégarbane
Bruno
B
Théodore
Jonathan
J
Deye
Nicolas
N
Nemeth
Judith
J
Valleur
Patrice
P
Baud
Frederic J
FJ
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007082:Ileum / Q000187:drug effects / Q000473:pathology; D007238:Infarction / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D007511:Ischemia / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D007583:Jejunum / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D011041:Poisoning / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D014662:Vasoconstrictor Agents; D009638:Norepinephrine; D004837:Epinephrine