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[Faecal impaction in elderly patients is a potential severe condition].

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Opioid-induced constipation can lead to severe fecal impaction, especially in immobilized patients. This case highlights the critical need for preventative laxative use with transdermal buprenorphine to avoid serious complications.

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Area of Science:

  • Geriatrics
  • Pharmacology
  • Gastroenterology

Background:

  • Transdermal buprenorphine is an effective analgesic, but its use requires careful monitoring for side effects.
  • Constipation is a common adverse effect of opioid analgesics, particularly in elderly and immobilized individuals.

Observation:

  • An elderly, hemiparetic male developed severe, dark-colored emesis and presented with a tense, enlarged abdomen.
  • A computed tomography (CT) scan revealed a massive fecal impaction measuring 19 cm in width.

Findings:

  • Despite interventions including enemas and endoscopic disimpaction, surgical intervention was necessary due to the severity of the fecal impaction.
  • The patient's condition deteriorated, leading to death shortly after hospital discharge.

Implications:

  • This case underscores the critical importance of proactive constipation management, including the routine use of laxatives, when initiating opioid therapy, especially transdermal buprenorphine.
  • Preventative measures are crucial to mitigate the risk of life-threatening fecal impaction in immobilized patients receiving opioid analgesics.