Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2017; 23(21): 3934-3944
Published online Jun 7, 2017. doi: 10.3748/wjg.v23.i21.3934
Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon
Zong-Ming Zhang, Xiang-Chun Lin, Li Ma, An-Qin Jin, Fang-Cai Lin, Zhuo Liu, Li-Min Liu, Chong Zhang, Na Zhang, Li-Juan Huo, Xue-Liang Jiang, Feng Kang, Hong-Jun Qin, Qiu-Yang Li, Hong-Wei Yu, Hai Deng, Ming-Wen Zhu, Zi-Xu Liu, Bai-Jiang Wan, Hai-Yan Yang, Jia-Hong Liao, Xu Luo, You-Wei Li, Wen-Ping Wei, Meng-Meng Song, Yue Zhao, Xue-Ying Shi, Zhao-Hui Lu
Zong-Ming Zhang, Fang-Cai Lin, Zhuo Liu, Li-Min Liu, Chong Zhang, Hong-Wei Yu, Hai Deng, Ming-Wen Zhu, Zi-Xu Liu, Bai-Jiang Wan, Hai-Yan Yang, Jia-Hong Liao, Xu Luo, You-Wei Li, Wen-Ping Wei, Meng-Meng Song, Yue Zhao, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
Xiang-Chun Lin, Department of Gastroenterology, Peking University International Hospital, Beijing 102206, China
Li Ma, Asian Liver Center and Department of Surgery, School of Medicine, Stanford University, Stanford, CA 94305, United States
An-Qin Jin, Department of Gastroenterology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
Na Zhang, Li-Juan Huo, Department of Gastroenterology, First Hospital, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Xue-Liang Jiang, Department of Gastroenterology, Jinan Military General Hospital, Jinan 250031, Shandong Province, China
Feng Kang, Hong-Jun Qin, Department of Radiology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
Qiu-Yang Li, Department of Pathology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
Xue-Ying Shi, Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
Zhao-Hui Lu, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Author contributions: Zhang ZM, Lin XC, Ma L, Jin AQ, Lin FC, Liu Z, Liu LM, Zhang C, Zhang N, Huo LJ, Jiang XL, Kang F, Qin HJ, Li QY, Yu HW, Deng H, Zhu MW, Liu ZX, Wan BJ, Yang HY, Liao JH, Luo X, Li YW, Wei WP, Song MM, Zhao Y, Shi XY and Lu ZH performed the study; Zhang ZM, Lin XC, Ma L and Jin AQ collected and analyzed the data; Zhang ZM provided the funding; Zhang ZM, Lin XC and Ma L designed the study and wrote the manuscript.
Supported by the Science and Technology Project of State Grid Corporation of China, No. SGHB0000AJJS1400182.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, China.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zong-Ming Zhang, MD, PhD, Professor and Chair, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, No. A1, Taipingqiaoxili, Fengtai District, Beijing 100073, China. zhangzongming@mail.tsinghua.edu.cn
Telephone: +86-10-63503046 Fax: +86-10-63465865
Received: March 22, 2017
Peer-review started: March 22, 2017
First decision: March 31, 2017
Revised: April 4, 2017
Accepted: May 15, 2017
Article in press: May 15, 2017
Published online: June 7, 2017
Processing time: 76 Days and 19.5 Hours
Abstract

A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of drug-induced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids.

Keywords: Benign colonic stenosis; Compound Qingdai pill; Self-expandable memory metallic stent

Core tip: This case demonstrated that detailed inquiry of medical history and effective auxiliary examinations are important for accurate diagnosis. Endoscopic balloon dilatation and metal stent implantation played key roles in the differential diagnosis and bridge treatment of benign colon stenosis. Finally, adequate awareness of drug-induced sigmoid stenosis is very important for avoiding misdiagnosis and mistreatment.