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Intestinal infarction complicating phenobarbital overdose.

K R Olson, S M Pond, E D Verrier

Archives of Internal Medicine

|February 1, 1984

Summary

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Phenobarbital overdose can lead to nonocclusive intestinal infarction, a rare condition. This case highlights a unique gastrointestinal complication following a drug overdose.

Area of Science:

Gastroenterology
Toxicology
Surgery

Background:

Phenobarbital is a commonly prescribed barbiturate for seizure disorders and insomnia.
Drug overdoses, particularly with central nervous system depressants, can lead to various systemic complications.
Intestinal infarction is a serious condition involving tissue death in the intestines, often due to vascular compromise.

Observation:

A 29-year-old male presented with symptoms of nonocclusive intestinal infarction 72 hours after a phenobarbital overdose.
Initial abdominal examination revealed no abnormalities, and the patient was not hypotensive.
Within 10 hours, the patient developed abdominal distention, ileus, and gas in the intestinal wall and portal venous system.

Findings:

Laparotomy confirmed ischemic intestinal infarction affecting the right colon and distal ileum.

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Crucially, there was no evidence of mesenteric vessel thrombosis, indicating a nonocclusive cause.

The patient underwent ileostomy with subsequent reanastomosis and made a full recovery.

Implications:

This case represents the first reported instance of ischemic intestinal infarction secondary to a phenobarbital overdose.
It underscores the potential for severe, unexpected gastrointestinal complications following drug overdose.
Highlights the importance of considering nonthrombotic mesenteric ischemia in patients with gastrointestinal distress after drug intoxication.