Calcium carbonate
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False positive appearance of small bowel colonic fistula: case report A 57-year-old woman developed false positive appearance of small bowel-colonic fistula during treatment with calcium carbonate for unspecified chemotherapy-induced nausea and acid reflux. The woman, who had a history of stage IV breast cancer with bone metastases, developed a rectovaginal fistula due to recurrent sigmoid diverticulitis. Her anamnesis revealed laparoscopic sigmoid colectomy, colovaginal fistula and lysis of adhesions. On postoperative day 2, CT abdomen pelvis with intravenous contrast revealed expected postoperative changes along with a complex postoperative fluid collection adjacent to anastomosis staple line, however anastomotic leak was also not excluded. Two weeks later, a follow-up rectal contrast scan confirmed a persistent rectovaginal fistula and an anastomotic leak. Six weeks later, CT pelvis with rectal contrast revealed a new leak at the surgical staple site. However, no evidence of a persistent rectovaginal fistula was attained. Additionally, multifocal intraluminal hyper density were observed in the small bowel loops anterior to and in close proximity to the surgical site and distal colon. A new concern of fistulous connection between the small bowel and the distal colon was raised. She was on unspecified chemotherapy for metastatic breast cancer and a surgical intervention with chemotherapy interruption was advised. Prior to surgical intervention, a detailed patient history revealed ingestion of calcium carbonate [Tums] tablets for chemotherapy-induced acid reflux and nausea. The prescribed dose was 1000mg twice daily, however she had taken increased dose due to worsening symptoms. Afterwards, differential diagnosis of hyperdensity secondary to calcium carbonate use was made. She was scheduled for a diagnostic laparoscopy which required hospitalisation. During the procedure, a cuffleak test was performed with sodium chloride [saline] following rectal insufflation. No evidence of air bubbles were noted. The device was also tested at the surgical anastomosis site and no evidence of a anastomotic leak and small bowel fistula was noted. A diagnosis of false positive appearance of small bowel colonic fistula attributed to calcium carbonate was confirmed [duration of treatment to reaction onset not stated]. The woman underwent reversal of the diverting loop ileostomy and enterolysis of adhesions. Coelho MP, et al. Intraluminal hyperdense appearance of the small bowel on high resolution computed tomography of the abdomen and pelvis secondary to use of Calcium Carbonate tablets (Tums) mimicking a small bowel fistula. Radiology Case Reports 15: 1875-1878, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1016/ 803500463 j.radcr.2020.07.044
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Reactions 12 Sep 2020 No. 1821
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