Lactulose-Induced Pneumatosis Intestinalis Causing Sudden Deterioration in a Patient With Advanced Hepatic Disease

Area of Science:

• Gastroenterology
• Internal Medicine
• Pharmacology

Background:

• Hepatic encephalopathy (HE) is a serious complication of advanced liver disease.
• Lactulose is a standard osmotic laxative used to reduce ammonia levels in patients with HE.
• Pneumatosis intestinalis (PI) is a rare condition characterized by the presence of gas within the intestinal wall.

Observation:

• A 53-year-old male with HE developed acute, severe pneumatosis intestinalis (PI) during lactulose treatment.
• The PI persisted even after lactulose was discontinued.
• The patient's condition rapidly declined, necessitating palliative care and leading to death.

Findings:

• This case suggests a potential link between lactulose therapy and the development of severe PI.
• Unlike some reported cases, PI symptoms did not resolve upon lactulose cessation in this patient.
• Lactulose may pose a significant risk in patients with advanced hepatic disease and comorbidities.

Implications:

• Clinicians should exercise caution when prescribing lactulose to patients with advanced liver disease and multiple comorbidities.
• Further research is needed to understand the mechanisms and risk factors associated with lactulose-induced PI.
• This case underscores the importance of vigilant monitoring for adverse events during HE treatment.