Colonic strictures

For ulcerative colitis, colectomy may be performed when the patient has disease uncontrolled by maximum medical therapy or when there are complications of the disease such as colonic perforation, toxic dilatation (megacolon), uncontrolled colonic hemorrhage, or colonic strictures. 

Pancreatic enzyme supplements are well tolerated. The capsules should be swallowed, not chewed, because pancreatic enzymes may cause oropharyngeal mucositis. Excessive doses may cause diarrhea and abdominal pain. The high purine content of pancreas extracts may lead to hyperuricosuria and renal stones. Several cases of colonic strictures were reported in patients with cystic fibrosis who received high doses of pancrelipase with high lipase activity. These high-dose formulations have since been removed from the market. 

Cystic fibrosis and colonic strictures. Editorial. J Clin Gastroenterol 21 2, 1995. 

Colonic stricture, similar to ileum diaphragm disease, developed in a patient during prolonged administration of modified-release diclofenac (12). Pseudomembranous colitis and colonic ulceration, with or without a diaphragm-like colonic stricture, have been reported (SEDA-16, 110) (SEDA-17, 109). Dispersible diclofenac is a formulation from which absorption is more rapid than... 

Huber T, Ruchti C, Halter F. Nonsteroidal antiinflammatory drug-induced colonic strictures a case report. Gastroenterology 1991 100(4) 1119-22. 

Acute colitis demonstrated by endoscopy and rechallenge was reported in two patients taking etodolac for arthritis (8). Colonic strictures have been described in another report (SEDA-22, 115). 

Like other NSAIDs, a diaphragm-hke right-sided colonic stricture has been described in a woman taking indo-metacin suppositories (27). Perforation of colonic diverticula has been described (28). 

For patients who are unable to swallow capsules, the contents may be emptied into applesauce, jelly, or some other nonalkatine vehicle, provided that the patient does not chew the microencapsulated beads. Side effects of pancreatic enzyme products are uncommon. Perianal irritation resembling diaper rash may occur in infants fed excess quantities of enzyme powders. Hyperuricosuria also has been reported to occur secondary to pancreatic enzyme use, apparently related to their high purine content. Proximal colonic stricture (fibrosing colonopathy) is a dose-related side effect associated with lipase doses in excess of 24,000 units/kg per day. ... 

Bowel obstruction may be present at birth due to meconium ileus. Older children might present with distal intestinal obstruction syndrome (DIOS), colonic stricture(s) and, less commonly, intussusception, fecal impaction of the appendix, gastroesophageal reflux or recurrent rectal prolapse (Fig. 5.24). 

Conventional colonoscopy is also not without risk to the patient and significant morbidity and mortality has been reported (Garbay et al. 1996). The most common adverse outcome associated with conventional colonoscopy includes hemorrhage and perforation. The rate of perforation of the colon ranges from 0.2 to 0.4% after diagnostic colonoscopy, increases with polypectomy, and approximates 5% with hydrostatic balloon dilatation of colonic strictures (Zubarik et al. 1999). 

Occasionally, patients are unable to undergo conventional colonoscopy due to presence of a colonic stricture, redundant sigmoid, or contraindications to intravenous conscious sedation. Flexible sigmoidoscopy can be performed without sedation however, the majority of the colon is not evaluated. 

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