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Abstract

Ergotamine toxicity is rare complication, including tachycardia, arterial spasm, or ischemic colitis which occurring as a result of a treatment with the drug du to different conditions. We report a 54-year-old woman using an ergot-derived drug for migraine. Diagnosis of ergotamine intoxication begins with suspicion. Every doctor and surgeons should be aware of this acute dangerous condition.Keywords: Ischemic colitis; Ergotamine every 100,000 people per year [1]. People affected by this entity are mainly female over 60 years old [2]. However, there are cases reported in young people with no risk factors. Its presentation runs between mild transitory episodes to fulminant colitis that can lead to necrosis, perforation, peritonitis and death. The risk factors identified are high blood pressure, diabetes mellitus, dyslipidemia, coronary disease and drugs, such as NSAIDs, ergotamine, cocaine, antibiotics, cytotoxic drugs and vasoactive agents [3][4][5][6]. Case ReportA 54-year-old female was admitted in the emergency department for 24 hour-longmigraines, diarrhea, lower gastrointestinal bleeding (15 episodes) and left lower abdominal pain. The patient is a former smoker (6 pack/year) with a record of dyslipidemia, thalassemia minor and chronic migraine treated with ergotamine suppositories.Physical examination showed normal vital parameters, abdomen with mild defense and no peritoneal irritation. Traces of blood were found during the rectal examination. ii. Abdominal CT: Irregular wall thickening (>3mm) along the left portion of the large bowel with no compromise of the rectum, pericolic fat stranding, submucosal edema and enhancement of the mucosa after intravenous contrast administration (Figure 1).A complete colonoscopy with previous mechanical bowel preparation was performed. The findings include segmental erythema and areas with pale mucosa from the splenic flexure to the rectosigmoideal junction, with rectal spare. Petechial hemorrhages, haustrations edema and fibrin were also described. Biopsy specimens were obtained.Histologic examination showed epithelium erosion, mucosal and sub mucosal hemorrhage, atrophic crypts and a decrease in the number of caliciform cells. These findings were consistent with ischemic colitis. Conservative treatment was established, with the suppression of the ergotamine suppositories. The patient was discharged 48 hours after admission. No recurrent symptoms were reported. A colonoscopy was performed 6 months after the diagnosis, which showed remission of endoscopic findings (Figure 2).