title: Outcome of emergency surgery for severe neuroleptic-induced colitis: results of a prospective cohort.
abstract: OBJECTIVE
  The study evaluated the outcome of severe acute antipsychotic (neuroleptic) drug related colitis requiring emergency surgery.
  
  
  METHODS
  From 2009 to 2014, 20 patients underwent emergency surgery for acute and severe neuroleptic-related ischaemic colitis. Neuroleptic-induced colitis was defined as another cause besides inflammatory, infectious or ischaemic colitis with a relationship to treatment by antipsychotic drugs.
  
  
  RESULTS
  The main drugs involved were cyamemazine (n = 9, 45%), loxapine (n = 5, 25%), haloperidol (n = 4, 20%) and alimemazine (n = 4, 20%). Most (n = 14, 70%) patients presented with haemodynamic instability requiring massive resuscitation and vasopressive drugs. CT signs of digestive impairment were found in 13 (65%) patients having emergency surgery. The lesions were pancolonic in 40%; transparietal necrosis was found in 45% and 15% had colonic perforation. Twelve (60%) patients had total or subtotal colectomy and eight (40%) a segmental colectomy with colostomy or ileostomy in all cases. The postoperative mortality was 15% and morbidity was 70%, necessitating surgical reintervention in two (10%) patients. Of the 17 surviving patients, 11 (64.7%) had restoration of intestinal continuity after a median delay of 103 days, with a postoperative morbidity rate of 36.3%. In the intent-to-treat population, the permanent stoma rate was 30%.
  
  
  CONCLUSIONS
  The morbidity and mortality of surgery for neuroleptic-drug-induced colitis is higher than for colitis due to other causes. A better knowledge of this condition should lead to early diagnosis.
authors.affiliation: Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: S
authors.identifier: http://orcid.org/0000-0001-7666-9497
authors.initials: S
authors.lastname: Abdalla
authors.affiliation: Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: A
authors.initials: A
authors.lastname: Brouquet
authors.affiliation: Department of Pathology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: T
authors.initials: T
authors.lastname: Lazure
authors.affiliation: Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: B
authors.initials: B
authors.lastname: Costaglioli
authors.affiliation: Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: C
authors.initials: C
authors.lastname: Penna
authors.affiliation: Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: S
authors.initials: S
authors.lastname: Benoist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D017091:Colitis, Ischemic / Q000139:chemically induced / Q000401:mortality / Q000601:surgery*; D003125:Colostomy / Q000379:methods / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods / Q000706:statistics & numerical data*; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
keywords: Neuroleptic induced colitis; morbidity; surgery