Dr Jitendra Singh at Department of General Surgery, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences (P.G.I.M.S.), Rohtak-124001, Haryana, India. and colleagues have reported rare cases of Gut Gangrene. The case has appeared in the Journal of case reports.
A gangrenous gut is a highly fatal condition most often caused by mesenteric ischemia or intestinal obstruction and requires emergency surgical intervention. There is no definite evidence about the role of anti-epileptics as a cause of gut gangrene.
Case 1
A 33-year-old, male presented in the emergency department with complaints of right iliac fossa pain, loose stools and vomiting for three days. The patient was a known case of seizure disorder for which he was taking sodium valproate tablets on a daily basis for last one year. On examination, the abdomen was soft with tenderness over right iliac fossa. His hemoglobin was 11.2 gm/dL and total leukocyte counts were 14,000/mm3. Ultrasonography of the abdomen was suggestive of the inflammed appendix with minimal fluid present in pelvis. The patient was diagnosed as a case of a burst appendix. The patient underwent emergency exploratory laparotomy with the following intra-operative finding i.e. around 100 cc of purulent fluid present in peritoneal cavity; pus flakes present over gut and parities in right iliac fossa; gangrenous appendix, cecum and proximal ascending colon with cecal perforation; dense adhesion present between omentum, gangrenous gut, and parities. Resection of gangrenous gut with end ileostomy with appendicectomy was performed. Patient had an uneventful post-operative period and was discharged on postoperative day thirteenth. Ileostomy closure was performed two months later on an elective basis.
Case 2
A 24-year-old, male presented in emergency department with complaints of pain abdomen localizing to right lower quadrant and vomiting for six days; associated with fever and non-passage of flatus and stool for two days. He was on anti-epileptic, sodium valproate for past six months prescribed by private hospital and is undergoing investigations for the demyelinating plaques present over C3, C4. Abdominal examination revealed a soft and tender abdomen localizing to right iliac fossa; a palpable lump measuring approximately 4×3 cm at right lower quadrant. Routine laboratory investigations were sent and his hemoglobin was found to be 8.9 gm/dL and total leukocyte counts were 13,000/mm3. Ultrasonography of the abdomen was suggestive of burst appendix. Patient underwent emergency exploratory laparotomy with resection of gangrenous gut with end ileostomy. Intra-operatively, around 200 cc of purulent fluid present in peritoneal cavity; gangrenous cecum, ascending colon with omentum adherent to them; terminal ileum was found edematous and adherent to gangrenous colon; pus flakes were present over liver, omentum, and ileum. After an uneventful post-operative hospital stay patient was discharged under stable conditions and planned for ileostomy closure two months later.
For more details click on the link: DOI:http://dx.doi.org/10.17659/01.2018.0076
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