Methylnaltrexone-Associated Bowel Perforation in Postoperative Opioid-Induced Constipation and Ogilvie Syndrome: A Case Report

A A Pract. 2019 Jan 15;12(2):44-46. doi: 10.1213/XAA.0000000000000840.

Abstract

Pain management with opioids is often limited by medication side effects. One of the most common and distressing side effects is opioid-induced constipation (OIC), a syndrome that is now getting significant national attention. We report the case of an opioid-dependent 56-year-old man who underwent lumbar decompression for spinal stenosis. Postoperatively, he developed OIC and Ogilvie syndrome, then following treatment with methylnaltrexone experienced an acute bowel perforation. We briefly review the recommended management of OIC as well as indications and contraindications of methylnaltrexone and similar new medications.

Publication types

  • Case Reports

MeSH terms

  • Analgesics, Opioid / adverse effects*
  • Colonic Pseudo-Obstruction / diagnostic imaging
  • Colonic Pseudo-Obstruction / drug therapy*
  • Constipation / diagnostic imaging
  • Constipation / drug therapy*
  • Decompression, Surgical
  • Humans
  • Hydromorphone / adverse effects
  • Intestinal Perforation / etiology*
  • Low Back Pain / drug therapy
  • Male
  • Methadone / adverse effects
  • Middle Aged
  • Naltrexone / adverse effects
  • Naltrexone / analogs & derivatives*
  • Narcotic Antagonists / adverse effects*
  • Opioid-Related Disorders
  • Oxycodone / adverse effects
  • Postoperative Complications / drug therapy
  • Quaternary Ammonium Compounds / adverse effects
  • Spinal Stenosis / surgery*

Substances

  • Analgesics, Opioid
  • Narcotic Antagonists
  • Quaternary Ammonium Compounds
  • methylnaltrexone
  • Naltrexone
  • Oxycodone
  • Hydromorphone
  • Methadone