Acute Bowel Perforation Post-Bowel Preparation in a Patient with Connective Tissue Disease

Abstract

Isosmotic oral agents are commonly used in bowel preparation due to their minimal side effects. However, bowel perforation is a rare and severe complication. Connective tissue disease and medications such as nonsteroidal anti-inflammatory drugs/steroids can weaken the colonic wall, which increases the risk of perforation. We present a case of a 67-year-old male with undifferentiated mixed connective tissue disease who developed a bowel perforation after administration of bowel prep. The patient initially presented to the emergency department with diffuse abdominal pain, with imaging showing evidence of perforation. Despite surgical and medical intervention, the patient passed away.

Learning points: This case highlights that oral isosmotic agents that are commonly used for bowel preparation are not risk free.This case highlights that patients with connective tissue disease who receive bowel preparation with oral isosmotic agents are at increased risk for adverse events.

Keywords: Bowel preparation; bowel perforation; connective tissue disease.

Figure 1

Focal inflammatory changes in the region of the hepatic flexure of the colon with large adjacent abscess 16 × 10 × 10 cm (blue arrow). Associated pneumoperitoneum and free fluid in the right upper quadrant (yellow arrow).

Figure 2

Increased size fluid collections in the gastric hepatic space in the right upper quadrant compatible with abscesses (blue and yellow arrows).