Perforation of the Sigmoid Colon After Ingestion of a Hydrophilic Colloid

Abstract

A 50-year-old white man was seen with a chief complaint of abdominal pain of seven hours' duration, which had begun 30 minutes after breakfast. The pain had been preceded by a desire to defecate, after which a knife-like excruciating pain spread from the periumbilical region over the entire abdomen and continued unabated for five hours when the patient began to vomit clear gastric juice. Two weeks previously he had com¬ plained of constipation, and his wife, who was taking a hydro¬ philic bulk-increasing laxative containing synthetic gum methylcellulose (Hydrolose) in plain syrup form, suggested that he use this medicament. He then took 2 tablespoons daily for two days but the constipation was not improved. During the next week he passed small, hard, fecal marbles, and the fulness in the lower abdomen was not relieved. For several days prior to the present acute episode he again took the methylcellulose syrup, 1 tablespoon, at night. The day before he was admitted to the hospital he had passed a huge mass of stool after some straining.The patient's history of illness included occasional instances of sinus tachycardia and an acute suppurative perforated ap¬ pendicitis for which he had been operated on in 1939. During the past five years there had been occasional periods of consti¬ pation that were extremely discomforting. In April, 1951, he had complained of a »ense of fulness in the lower abdomen but an x-ray examination with a barium enema performed by one of us ( A. I. F.) was entirely negative except for moderate spasticity in the sigmoid colon. No diverticula were seen. He had been well until six months prior to this time when, because of several attacks of abdominal pain, he had visited his family physician who advised an x-ray examination with a barium meal. He was then told he had a duodenal ulcer. He was kept on a special diet until three weeks prior to the present illness when he was reexamined by roentgenogram and told that "everything was all right." Physical examination revealed an acutely distressed person doubled up with pain. The heart and lungs showed no ab¬ normalities. Blood pressure was 132/90 mm. Hg. The abdomen was rigid with marked tenderness throughout, especially in the right lower quadrant. When a rectal examination was made, several external bleeding hemorrhoids were discovered but no stool. Proctoscopic examination revealed a small amount of soft brown stool. The patient would not tolerate a sigmoidoscopic examination. The hemoglobin level (Sahli) was 13.6 gm.per 100 cc; there were 4,700,000 red blood cells and 5,200 whiteblood cells with a differential count of 65% polymorphonuclear leukocytes, 30% lymphocytes, 3% monocytes, and 2% eosinophils. The results of urinalysis were normal. A flat film of the abdomen taken with the patient in both erect and prone positions revealed fecal material throughout the descending colon; no definite subdiaphragmatic air pockets were observed. A diagnosis of a perforated duodenal ulcer was made on the basis of the history and clinical findings, and the ...

Large Bowel Perforation due to Excessive Bran Ingestion

“…Perforation of the large bowel is a known complication of synthetic bulk laxatives, both in the post‐operative period, 4 and when there is a ‘closed loop’ between an obstructing carcinoma and a competent ileo‐caecal valve 1,2 …”

Re‐evaluation of celluloses E 460(i), E 460(ii), E 461, E 462, E 463, E 464, E 465, E 466, E 468 and E 469 as food additives

“…Cases of oesophageal and GI obstruction have been reported in the literature following intake of methyl cellulose (Belmont, 1952;Hedayaty and Shuman, 1953;Friedman and Alessi, 1954;FDA, 2015), carboxy methyl cellulose (Leger et al, 1952;Monod-Broca, 1952;Soullard et al, 1952;Derobert and Heully, 1956;FDA, 2015) and cellulose fibre diet pills (Jones and Pillsbury, 1990).…”