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Multiple spontaneous small bowel perforations due to clozapine-Case report
A Rodrigues1, A Duarte1, A Marques1
1General Surgery Department of Centro Hospitalar do Oeste, Portugal.
International Journal of Surgery Case Reports
|November 18, 2018
Summary
Spontaneous small bowel perforation is rare. This case suggests antipsychotic medication, specifically clozapine, may cause intestinal ischemia and perforation, a previously undocumented adverse effect.
Area of Science:
- Gastroenterology
- Pharmacology
- Clinical Medicine
Background:
- Spontaneous small bowel perforation is an uncommon medical emergency.
- Multiple factors can cause small bowel perforation, including inflammatory, infectious, and vascular causes.
- Antipsychotic medications are known to have severe adverse effects, including intestinal ischemia.
Purpose of the Study:
- To report a rare case of spontaneous small bowel perforation.
- To investigate the potential link between clozapine use and intestinal ischemia.
- To highlight the diagnostic challenges and potential attribution of such perforations to antipsychotic adverse effects.
Main Methods:
- A clinical case study of a 42-year-old schizophrenic patient on clozapine.
- Physical examination, abdominal tomography, and emergency laparotomy were performed.
- Exclusion of common causes of spontaneous perforation and histological examination of tissue samples.
Main Results:
- The patient presented with symptoms of peritonitis and pneumoperitoneum.
- Multiple jejunal and ileal perforations were found during laparotomy.
- Histology revealed non-specific inflammatory findings and ischemia, with other causes excluded.
Conclusions:
- Spontaneous small bowel perforation is rare, and intestinal ischemia is a potential, albeit rare, adverse effect of antipsychotics like clozapine.
- While colon perforations are documented, small bowel perforations linked to clozapine are not.
- In this case, clozapine was identified as the likely cause after excluding other etiologies, and dose reduction was successful.
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