Vascular Occlusion of the Colon and Oral Contraceptives

Kilpatrick, Zachary M.; Silverman, James F.; Betancourt, Edgardo; Farman, Jack; Lawson, Jack

doi:10.1056/nejm196802222780807

Cited by 97 publications

(16 citation statements)

References 4 publications

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“…In a detailed review of the subject, Riley (157) has suggested that the disease was probably first recognized in 1971 (115) in five young adults with a condition referred to as "evanescent colitis." Subsequently, several sporadic cases of the syndrome, going by names such as ischemic colitis and "reversible segmental colitis," were described in the United States (87,148,159), Japan (168,201), and Europe (30, 110,200), although the etiology remained unclear.…”

Section: Hemorrhagic Colitismentioning

confidence: 99%

“…Classical HUS presents typically a few days after the onset of an acute diarrheal "prodromal" illness which is often bloody and shows remarkable similarities clinicopathologically (156) and radiologically (5,88,159,170) (86), the prodrome is nondiarrheal and may consist of upper or lower respiratory tract symptoms, fever, and vomiting. The other much less common types of HUS include a childhood form that is inherited (75) and adult forms that occur in association with pregnancy (29,172), oral contraceptive use (13,87), malignant hypertension (11,105), and various chronic illnesses (42,51).…”

Section: Hemorrhagic Colitismentioning

confidence: 99%

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Infection by verocytotoxin-producing Escherichia coli

1989

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Verocytotoxin (VT)-producing Escherichia coli (VTEC) are a newly recognized group of enteric pathogens which are increasingly being recognized as common causes of diarrhea in some geographic settings. Outbreak studies indicate that most patients with VTEC infection develop mild uncomplicated diarrhea. However, a significant risk of two serious and potentially life-threatening complications, hemorrhagic colitis and the hemolytic uremic syndrome, makes VTEC infection a public health problem of serious concern. The main reservoirs of VTEC appear to be the intestinal tracts of animals, and foods of animal (especially bovine) origin are probably the principal sources for human infection. The term VT refers to a family of subunit exotoxins with high biological activity. Individual VTEC strains elaborate one or both of at least two serologically distinct, bacteriophage-mediated VTs (VT1 and VT2) which are closely related to Shiga toxin and are thus also referred to as Shiga-like toxins. The holotoxins bind to cells, via their B subunits, to a specific receptor which is probably the glycolipid, globotriosyl ceramide (Gb3). Binding is followed by internalization of the A subunit, which, after it is proteolytically nicked and reduced to the A1 fragment, inhibits protein synthesis in mammalian cells by inactivating 60S ribosomal subunits through selective structural modification of 28S ribosomal ribonucleic acid. The mechanism of VTEC diarrhea is still controversial, and the relative roles of locally acting VT and "attaching and effacing adherence" of VTEC to the mucosa have yet to be resolved. There is increasing evidence that hemolytic uremic syndrome and possibly hemorrhagic colitis result from the systemic action of VT on vascular endothelial cells. The role of antitoxic immunity in preventing the systemic complications of VTEC infection is being explored. Antibiotics appear to be contraindicated in the treatment of VTEC infection. The most common VTEC serotype associated with human disease is O157:H7, but over 50 different VT-positive O:H serotypes have now been identified. The best strategies for diagnosing human VTEC infection include testing for the presence of free VT in fecal filtrates and examining fecal cultures for VTEC by means of deoxyribonucleic acid probes that specify genes encoding VT1 and VT2. Both methods are currently confined to specialized laboratories and await commercial development for wider use. In the meantime, most laboratories should continue to screen for the most common human VTEC serotype, O157:H7, using a sorbitol-containing MacConkey medium.

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Section: Hemorrhagic Colitismentioning

confidence: 99%

Section: Hemorrhagic Colitismentioning

confidence: 99%

Infection by verocytotoxin-producing Escherichia coli

1989

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“…The first two cases were documented by Kilpatrick et al in 1968, and since then more cases have been described by Hurwitz et al (1970) and Cotton and Lea Thomas (1971). The patients were young women without any known predisposing vascular disorders who were taking an oral contraceptive.…”

Section: Discussionmentioning

confidence: 93%

Small bowel ischaemia and infarction in young women taking oral contraceptives and progestational agents

Hoyle¹,

Kennedy²,

Prior³

et al. 1977

British Journal of Surgery

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Case histories of three young women who suffered small bowel infarction associated with oral contraceptives and progestational agents are presented. Two infarctions were due to superior mesenteric artery thrombosis and one to superior mesenteric vein thrombosis. All of these patients were of blood group A and smokers, factors which are known to predispose to vascular thrombosis. A study was made of 18 additional cases reported in the literature. It was found that many of these cases presented with a history of symptoms of 2 weeks of more and at operation some of the cases appeared to be reversible. One case was reported where apparent reversion of the process of vascular thrombosis occurred after cessation of the oral contraceptive.

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“…Five years later, two cases of reversible ischemic colitis and two others manifesting massive infarction of the midgut were described [13,14]. Subsequent observations included several cases of druginduced intestinal infarction due to surgically proven mesenteric vein thrombosis [15,17,20] as well as multiple examples of reversible ischemic enteritis and colitis [16,18,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…H o w e v e r , it should be realized that the ultimate course of the disease cannot be predicted solely on the basis of initial barium studies. Conservative management with heparin, dextran infusion, and discontinuance of the contraceptive agent should be attempted in patients without signs of peritoneal irritation and radiographic findings of intestinal necrosis [13,16,17,25]. However, the persistence or progression of the clinical and radiologic findings would indicate the iaecessity for surgical intervention because bowel infarction is often insidious when caused by venous occlusion [17].…”

Section: Discussionmentioning

confidence: 99%

Ischemic disease of the small bowel and colon associated with oral contraceptives

Ghahremani

Meyers

Farman

et al. 1977

Gastrointest Radiol

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The widespread use of hormonal contraceptive pills by young women has caused a documented increase in thromboembolic disorders. This article describes yet another of the drug-induced complications namely, the development of ischemic bowel disease in seven cases. The ischemic changes which involved the small intestine in three and the colon in four patients became reversible after conservative management and discontinuance of oral contraceptive agents. The importance of clinical and radiologic consideration of ischemic bowel disease in young females receiving birth control pills is emphasized.

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Vascular Occlusion of the Colon and Oral Contraceptives

Cited by 97 publications

References 4 publications

Infection by verocytotoxin-producing Escherichia coli

Infection by verocytotoxin-producing Escherichia coli

Small bowel ischaemia and infarction in young women taking oral contraceptives and progestational agents

Ischemic disease of the small bowel and colon associated with oral contraceptives

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