. 2016 Dec;2(1):18.

doi: 10.1186/s40792-016-0145-6. Epub 2016 Feb 20.

Induction of potentially lethal hypermagnesemia, ischemic colitis, and toxic megacolon by a preoperative mechanical bowel preparation: report of a case

Masahiko Sugiyama^{1

2}, Eiji Kusumoto³, Mitsuhiko Ota⁴, Yasue Kimura⁵, Norifumi Tsutsumi⁶, Eiji Oki⁷, Yoshihisa Sakaguchi⁸, Tetsuya Kusumoto⁹, Koji Ikejiri¹⁰, Yoshihiko Maehara¹¹

Affiliations

¹ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ma-sa-s@surg2.med.kyushu-u.ac.jp.
² Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. ma-sa-s@surg2.med.kyushu-u.ac.jp.
³ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. aeg@kyumed.jp.
⁴ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ohta@kyumed.jp.
⁵ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. yasuek@surg2.med.kyushu-u.ac.jp.
⁶ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. tnori@kyumed.jp.
⁷ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. okieiji@surg2.med.kyushu-u.ac.jp.
⁸ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ysakaguchi@kyumed.jp.
⁹ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. kusumoto-t@kyumed.jp.
¹⁰ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ikejiri@kyumed.jp.
¹¹ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. maehara@surg2.med.kyushu-u.ac.jp.

PMID: 26943694
PMCID: PMC4761353
DOI: 10.1186/s40792-016-0145-6

Induction of potentially lethal hypermagnesemia, ischemic colitis, and toxic megacolon by a preoperative mechanical bowel preparation: report of a case

Masahiko Sugiyama et al. Surg Case Rep. 2016 Dec.

. 2016 Dec;2(1):18.

doi: 10.1186/s40792-016-0145-6. Epub 2016 Feb 20.

Authors

Masahiko Sugiyama^{1

2}, Eiji Kusumoto³, Mitsuhiko Ota⁴, Yasue Kimura⁵, Norifumi Tsutsumi⁶, Eiji Oki⁷, Yoshihisa Sakaguchi⁸, Tetsuya Kusumoto⁹, Koji Ikejiri¹⁰, Yoshihiko Maehara¹¹

Affiliations

¹ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ma-sa-s@surg2.med.kyushu-u.ac.jp.
² Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. ma-sa-s@surg2.med.kyushu-u.ac.jp.
³ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. aeg@kyumed.jp.
⁴ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ohta@kyumed.jp.
⁵ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. yasuek@surg2.med.kyushu-u.ac.jp.
⁶ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. tnori@kyumed.jp.
⁷ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. okieiji@surg2.med.kyushu-u.ac.jp.
⁸ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ysakaguchi@kyumed.jp.
⁹ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. kusumoto-t@kyumed.jp.
¹⁰ Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan. ikejiri@kyumed.jp.
¹¹ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. maehara@surg2.med.kyushu-u.ac.jp.

PMID: 26943694
PMCID: PMC4761353
DOI: 10.1186/s40792-016-0145-6

Abstract

A 67-year-old man was diagnosed with rectal cancer. The tumor invaded the subserosal layer, but it was not large, and there was no sign of obstruction. Neo-adjuvant chemotherapy reduced the size of the tumor. The patient was admitted to our hospital for surgery. For mechanical bowel preparation, he ingested 34 g of magnesium citrate (Magcorol P®), but then developed severe shock, a disturbance of consciousness, and acidemia, and he required catecholamines and mechanical ventilation. X-ray, CT, and laboratory tests revealed ischemic colitis, toxic megacolon, and hypermagnesemia (16.3 mg/dL). After 2 days of temporary hemodialysis and an enema to reduce his blood magnesium concentration, he recovered and left the intensive care unit. However, the left side of his colon had suffered ischemic damage and become irreversibly atrophied. One month later, he underwent laparoscopic abdominoperineal resection and left-side colectomy for the rectal cancer and severe ischemic colitis of the left side of the colon. Histopathology confirmed the rectal cancer with a grade 2 chemotherapeutic effect and severe ischemic colitis of the left side of the colon. Hence, the present case suggests that severe ischemic colitis, toxic megacolon, and hypermagnesemia can occur after taking a magnesium laxative without obstruction of the intestine.

Keywords: Hypermagnesemia; Ischemic colitis; Mechanical bowel preparation; Toxic megacolon.

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Figures

**Fig. 1**
Clinical course and value of the patient. Mg magnesium, HR heart rate, *SBP* systolic blood pressure, *DBP* diastolic blood pressure

**Fig. 2**
Abdominal X-ray examination revealed 6-cm dilatation of the sigmoid colon with fecal impaction

**Fig. 3**
Colonoscopy showed a severe ulcer and pseudomembrane at the descending colon

**Fig. 4**
Contrast enema examination revealed significant stenosis on the left side of the transverse colon to the descending colon

**Fig. 5**
Pathological findings showed advanced rectal cancer and significant atrophic changes and a longitudinal ulcer at the transverse colon and descending colon. The findings were compatible to ischemic colitis

See this image and copyright information in PMC

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Induction of potentially lethal hypermagnesemia, ischemic colitis, and toxic megacolon by a preoperative mechanical bowel preparation: report of a case

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Induction of potentially lethal hypermagnesemia, ischemic colitis, and toxic megacolon by a preoperative mechanical bowel preparation: report of a case

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