title: Hepatic venous outflow block caused by compressive fecaloma in a schizophrenic patient treated with clozapine.
abstract: In Clozapine users constipation is among the reported side effects including agranulocytosis and myocarditis with prevalence rates ranging from 14% to 60%. In extreme cases this may lead to bowel obstruction and paralytic ileus which, if not detected and treated early, may lead to mortality up to 30%. We report the first case of hepatic outflow block secondary to compression of the liver by a distended colon upstream an impacted fecaloma in a 47-year old schizophrenic man treated by clozapine. Emergency sub-total colectomy was performed for pan-colonic ischemia. Surgery relieved the liver outflow block and was followed by uneventful outcome. Patients receiving clozapine should undergo routine laxatives and monitoring in order to limit the risk of clozapine-related ileus and bowel ischemia.
authors.affiliation: Henri Mondor Hospital, Department of Hepato-Pancreato-Biliary and Liver Transplantation.
authors.forename: Michael
authors.initials: M
authors.lastname: Osseis
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.forename: Eylon
authors.initials: E
authors.lastname: Lahat
authors.forename: Alexandre
authors.initials: A
authors.lastname: Doussot
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D006502:Budd-Chiari Syndrome / Q000209:etiology*; D003024:Clozapine / Q000009:adverse effects*; D005244:Fecal Impaction / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine