PEG 3350
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Sigmoid volvulus following ingestion of a PEG 3350-containing solution in an elderly patient: case report A 77-year-old man, who was receiving haemodialysis and had taken laxatives for chronic constipation, developed sigmoid volvulus after ingesting a PEG 3350-containing solution in preparation for colonoscopy. The man, who had experienced intermittent abdominal discomfort over the previous 2 weeks and was scheduled to undergo a colonoscopy, ingested 4 litres of a PEG 3350-containing solution [Colyte; dosage not clearly stated]. He did not pass stools and experienced progressive abdominal pain and distension. After 16 hours, he presented with acute abdominal pain. On examination, he had a BP of 150/90mm Hg, a HR of 88/min, a respiratory rate of 20/min and a temperature of 37.6°C. He had a severely distended, rigid abdomen that was tender on palpation. Laboratory investigations revealed the following serum levels: WBC count 3400/mm3, platelet count 131 000/mm3, haematocrit 24.2% , haemoglobin 8.0 g/dL, creatinine 4.9 mg/dL, potassium 3.2 mEq/L, total protein 4.5 g/dL and albumin 2.5 g/dL. Radiography revealed a markedly dilated intestinal loop shaped like an inverted-U and an empty rectum. Acute colonic obstruction was suspected. On CT scan, the wall of his sigmoid colon was markedly thickened and oedematous, and he had a large amount of ascites. The man underwent emergency sigmoidoscopy, revealing mucosal folds that were winded counterclockwise 20cm above the anus and resulted in colonic obstruction. Due to possible sigmoid colon strangulation, emergency surgery was performed. His sigmoid colon was torsioned with gangrenous changes and a marked dilation of the descending colon proximal to the lesion was found. He underwent colonoscopy, and the upper rectum and sigmoid colon were resected. He had no recurrence of intestine obstruction within 3 months following his operation. Author comment: "The patient was old and had chronic renal failure requiring hemodialysis and chronic constipation, which might have predisposed the colon to become loose and elongated. . . ingestion of a large amount of a nonabsorbable Colyte solution during a short period had an additive effect on these predisposing factors, which altogether might have led to the development of sigmoid volvulus." Kim G, et al. Sigmoid volvulus ocurring during bowel preparation period before colonoscopy in a hemodialysis patient. Clinical Nephrology 66: 149-150, No. 2, 801046929 Aug 2006 - South Korea
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Reactions 14 Oct 2006 No. 1123
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