Nicorandil
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Anal ulcer in an elderly patient: case report A 74-year-old woman, who had an ischaemic heart disorders and hypertension, developed an anal ulcer during treatment with nicorandil [therapeutic indication not clearly stated]. The woman started receiving nicorandil 10mg twice daily and, about 4 years later, she developed anal ulceration. She presented with a 4-month history of constant severe perianal pain, bright red per rectum bleeding, anal discharge and constipation; 10 months before she presented with the ulcer, nicorandil had been increased to a maximal dose of 40mg twice daily. On perianal examination, she had a wellcircumscribed 3 × 4cm posterial anal ulcer, which was deep, ‘punched out’, with slough and fibres of the internal anal sphincter in the base. EUA [sic] and ulcer biopsy was performed. Fibroadipose tissue with fibrosis and chronic inflammation was revealed by histology. The woman received oral laxatives and regular dressings, but her severe pain persisted and there was no evidence of ulcer healing. She underwent defunctioning loop colostomy. Subsequently, nicorandil was stopped. Discontinuation of nicorandil and faecal diversion resulted in progressive healing of her ulcer. Al-Hilli Z, et al. Nicorandil related anal ulcer. Irish Journal of Medical Science 801054515 175: 62-63, No. 3, Jul-Sep 2006 - Ireland
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Reactions 9 Dec 2006 No. 1131
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