Barium enema: An outpatient procedure in the early diagnosis of acute appendicitis

Abstract

Both of our patients, young girls with ulcerative colitis, developed the onset of fever, vomiting, and bloody diarrhea after the ingestion of SAS. We believe that these symptoms were not secondary to the underlying ulcerative colitis because they were reproducible in each patient and resolution was more rapid than could be expected with ulcerative colitis. Patient 1 presented with symptoms characteristic of ulcerative colitis. When treated with SAS her condition deteriorated and did not improve until the SAS was discontinued. Symptoms returned during two subsequent challenges although she was clinically well on both occasions and in complete remission on one. Similarly Patient 2 developed symptoms each time she was treated with SAS. Her colitis was quiescent at the time of each challenge. Both patients tolerate aspirin without evidence of gastrointestinal bleeding or upset. Numerous side effects have been reported with both sulfonamides and salicylates, but the combination of fever, vomiting, and bloody diarrhea has not been among them 8. 9 nor has bloody diarrhea been previously reported with SAS. 1~ We have no explanation for the toxicity observed in our patients. Physicians caring for patients with inflammatory bowel disease should be aware that the onset of fever, vomiting, and bloody diarrhea may be due to SAS and not to a flare-up of the disease. REFERENCES 1. Misiewicz J J, Lennard-Jones JE, Connell AM, Baron JH, and Avery Jones F: Controlled trial of sulfasalazine in maintenance therapy for ulcerative colitis, Lancet 1:185, 1965. 2. Goldman P, and Peppercorn MA: Sulfasalazine, N Engl J Med 293:20, 1975. 3. Das KM, Eastwood MA, McManus JPA, and Sircus W: Adverse reaction during salicylazosulfapyridine therapy and the relation with drug metabolism and acetylator phenotype, N Engl J Med 289:491, 1973. 4. Block MB, Genant HK, and Kirsner JB: Pancreatitis as an adverse reaction to salicylazosulfapyridine, N Engl J Med 282:380, 1970. 5. Lead Article. Sulfasalazine induced lung disease, Lancet 2:504, 1974. 6. Wallace IW: Neurotoxicity associated with a reaction to sulfasalazine, Practitioner 204:850, 1970. 7. Strom J: Toxic epidermal necrolysis (Lyell's Syndrome) Scand J Infect Dis 1:209, 1969. 8. Woodbury DM, and Fingl E: Analgesic, antipyretics, antiinflammatory agents and drugs employed in the therapy of gout, in Goodman A, and Gilman AG, editors: The pharmacological basis of therapeutics, New York, 1975, The Macmillan Company, pp 325-358. 9. Weinstein LS: Antimicrobial agents, sulfonamides and trimethoprimsulfmethoxazole, in Goodman A, and Gilman AG, editors: The pharmacologic basis of therapeutics, New York, 1975, The Macmillan Company, pp 1113-1129. 10. Schinagl EF: Pharmacia Laboratories Inc., Personal communication.