Acute ileus from steroid withdrawal simulating intestinal obstruction after surgery for ulcerative colitis |
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Authors: | M Stelzner J D Phillips E W Fonkalsrud |
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Institution: | Department of Surgery, UCLA School of Medicine 90024. |
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Abstract: | Sixty of 127 prednisone-dependent patients with ulcerative colitis who underwent colectomy and endorectal ileal pull-through with ileal reservoir and subsequent laparotomy with ileostomy closure (254 operations) during a 4-year period developed 95 episodes of intestinal obstruction during the early post-operative period. Acute ileus due to steroid withdrawal caused symptoms of intestinal obstruction in 43 patients (76 episodes), whereas true mechanical small-bowel obstruction occurred in only 17 patients (19 episodes). Symptoms of both conditions were similar; however, hypoactive bowel sounds, acute onset of emotional depression, no evidence of obstruction on radiologic contrast stomatogram or enema, and prompt relief of symptoms within 4 hours after intravenous administration of hydrocortisone acetate distinguished acute steroid withdrawal. Since ileus from acute steroid withdrawal occurred four times as frequently as mechanical small-bowel obstruction, prompt recognition and treatment should appreciably reduce postoperative morbidity and hospital costs. |
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