title: Induction of potentially lethal hypermagnesemia, ischemic colitis, and toxic megacolon by a preoperative mechanical bowel preparation: report of a case.
abstract: A 67-year-old man was diagnosed with rectal cancer. The tumor invaded the subserosal layer, but it was not large, and there was no sign of obstruction. Neo-adjuvant chemotherapy reduced the size of the tumor. The patient was admitted to our hospital for surgery. For mechanical bowel preparation, he ingested 34 g of magnesium citrate (Magcorol P®), but then developed severe shock, a disturbance of consciousness, and acidemia, and he required catecholamines and mechanical ventilation. X-ray, CT, and laboratory tests revealed ischemic colitis, toxic megacolon, and hypermagnesemia (16.3 mg/dL). After 2 days of temporary hemodialysis and an enema to reduce his blood magnesium concentration, he recovered and left the intensive care unit. However, the left side of his colon had suffered ischemic damage and become irreversibly atrophied. One month later, he underwent laparoscopic abdominoperineal resection and left-side colectomy for the rectal cancer and severe ischemic colitis of the left side of the colon. Histopathology confirmed the rectal cancer with a grade 2 chemotherapeutic effect and severe ischemic colitis of the left side of the colon. Hence, the present case suggests that severe ischemic colitis, toxic megacolon, and hypermagnesemia can occur after taking a magnesium laxative without obstruction of the intestine.
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ma-sa-s@surg2.med.kyushu-u.ac.jp.|Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. ma-sa-s@surg2.med.kyushu-u.ac.jp.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. aeg@kyumed.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusumoto
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ohta@kyumed.jp.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. yasuek@surg2.med.kyushu-u.ac.jp.
authors.forename: Yasue
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. tnori@kyumed.jp.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsutsumi
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. okieiji@surg2.med.kyushu-u.ac.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ysakaguchi@kyumed.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sakaguchi
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. kusumoto-t@kyumed.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kusumoto
authors.affiliation: Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ikejiri@kyumed.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Ikejiri
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. maehara@surg2.med.kyushu-u.ac.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
keywords: Hypermagnesemia; Ischemic colitis; Mechanical bowel preparation; Toxic megacolon