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Acute Hydronephrosis Secondary to Methadone-Induced Constipation
Sameer Kandhi1, Siddharth Chinta1, Ana P Urena Neme2
1Internal Medicine, BronxCare Health System, Bronx, USA.
Cureus
|June 20, 2022
Summary
Opioid-induced constipation, a common side effect, can cause severe complications. This case highlights how methadone-induced constipation led to ureter compression, hydronephrosis, and hydroureter.
Area of Science:
- Nephrology
- Gastroenterology
- Pharmacology
Background:
- Opioid-induced constipation (OIC) affects 40-60% of non-cancer patients on opioids.
- Methadone maintenance therapy is a common treatment for opioid use disorder.
- Severe constipation can lead to significant gastrointestinal and urinary complications.
Observation:
- A 71-year-old male on methadone maintenance presented with severe OIC and fecal impaction.
- The fecal impaction caused extrinsic compression of the right ureter.
- This compression resulted in right hydronephrosis and hydroureter.
Findings:
- Aggressive bowel regimen including stool softeners, laxatives, and enemas resolved the constipation.
- Resolution of constipation led to improvement in right hydronephrosis and hydroureter.
- Methadone-induced constipation can directly cause hydroureter/hydronephrosis via intestinal dilation.
Implications:
- Highlights a rare but serious complication of OIC in patients on methadone.
- Emphasizes the importance of proactive management of OIC to prevent urinary tract complications.
- Suggests that severe intestinal dilation from OIC can lead to obstructive uropathy.
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