Non-occlusive mesenteric ischemia induced by a polyethylene glycol with ascorbate-based colonic bowel preparation

Although conventional bowel preparation for colonoscopy rarely causes serious complications, such complications can be fatal and, therefore, require early recognition and prompt treatment. Herein, we report a case of non-occlusive mesenteric ischemia (NOMI) induced by polyethylene glycol with an ascorbate component (PEG + Asc) that was used as a colonic bowel preparation. An- 82-year-old woman with a medical history of hypertension, atrial fibrillation and mild chronic renal failure received a cancer screening colonoscopy. Four hours after the administration of PEG + Asc, she vomited and gradually developed abdominal distention. She went into hypovolemic shock, and a CT scan revealed a distal colon obstruction caused by fecal material. A colonoscopy identified focal necrotic mucosa between the rectum and descending colon, suggesting the occurrence of irreversible intestinal necrosis; consequently, she underwent emergency surgery. The operative and pathological findings showed a discontinuous area of necrosis from the anal margin to the ileum without thrombotic change in the main mesenteric arteries, consistent with a diagnosis of NOMI. NOMI is a rare but fatal disease that can advance to an irreversible stage before a definite diagnosis can be made. Since PEG + Asc is a hypertonic laxative solution, the possibility that dehydration might cause severe secondary complications must be considered.