Non-occlusive mesenteric ischemia induced by a polyethylene glycol with ascorbate-based colonic bowel preparation

Abstract

Although conventional bowel preparation for colonoscopy rarely causes serious complications, such complications can be fatal and, therefore, require early recognition and prompt treatment. Herein, we report a case of non-occlusive mesenteric ischemia (NOMI) induced by polyethylene glycol with an ascorbate component (PEG + Asc) that was used as a colonic bowel preparation. An- 82-year-old woman with a medical history of hypertension, atrial fibrillation and mild chronic renal failure received a cancer screening colonoscopy. Four hours after the administration of PEG + Asc, she vomited and gradually developed abdominal distention. She went into hypovolemic shock, and a CT scan revealed a distal colon obstruction caused by fecal material. A colonoscopy identified focal necrotic mucosa between the rectum and descending colon, suggesting the occurrence of irreversible intestinal necrosis; consequently, she underwent emergency surgery. The operative and pathological findings showed a discontinuous area of necrosis from the anal margin to the ileum without thrombotic change in the main mesenteric arteries, consistent with a diagnosis of NOMI. NOMI is a rare but fatal disease that can advance to an irreversible stage before a definite diagnosis can be made. Since PEG + Asc is a hypertonic laxative solution, the possibility that dehydration might cause severe secondary complications must be considered.