Olanzapine
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Worsening of constipation leading to perforation of rectosigmoid colon: case report A 51-year-old man developed worsening of constipation leading to perforation of rectosigmoid colon during treatment with olanzapine for schizophrenia. The man was admitted due to nausea, vomiting and severe abdominal pain after a heavy meal. He had a medical history of schizophrenia and constipation (since early adulthood). He had been receiving unspecified medications for a psychiatric condition for 10 years. One year prior to the hospitalisation, he started receiving olanzapine 5mg twice a day [route not stated]. His constipation had been worsening. Abdominal examination revealed generalised tenderness and rigidity. Upright abdominal x-ray demonstrated free air under both hemidiaphragm. Thereafter, he was transferred to the operating room for laparotomy. During laparotomy, diffuse peritonitis was observed, but no apparent cause was detected after a thorough inspection of his abdominal cavity. Hence, the incision was extended down to the pubis, and an oval ulcer was noted on the antimesenteric border of rectosigmoid junction. Faecal material was entering through the ulcer into the peritoneal cavity. Thereafter, sigmoid colostomy, irrigation of peritoneal cavity and Hartman pouch were performed. It was suspected that the olanzapine intensified his constipation, which led to colonic perforation [time to reactions onset not stated]. Hence, the man’s treatment with olanzapine was switched to flupentixol [Flupenthixol]. Ten weeks after the first operation, he underwent colostomy closure. During both the surgeries, no pathologic causes were detected. Subsequently, he was discharged. Sheikholeslami FH, et al. Spontaneous perforation of rectosigmoid colon. Iranian Journal of Medical Sciences 35: 339-341, No. 4, Dec 2010
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Reactions 14 Nov 2020 No. 1830
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