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

Masahiko Sugiyama,Yoshihisa Sakaguchi,Eiji Oki,Tetsuya Kusumoto,Yasue Kimura,Yoshihiko Maehara,Eiji Kusumoto,Koji Ikejiri,Norifumi Tsutsumi,Mitsuhiko Ota

doi:10.1186/s40792-016-0145-6

Masahiko Sugiyama, Yoshihisa Sakaguchi + Show 8 more

Open Access

https://doi.org/10.1186/s40792-016-0145-6

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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.

Highlights

Hypermagnesemia is considered to be very rare [1]; it is usually caused by a laxative overdose, and it may occur in patients with kidney dysfunction
We present a case of a patient with potentially lethal hypermagnesemia accompanied by ischemic colitis and toxic megacolon who took a laxative as part of surgical pretreatment
To the best of our knowledge, this is the first report in the literature of a triplet of hypermagnesemia, ischemic colitis, and toxic megacolon resulting from ingestion of a preoperative laxative

Summary

Background

Hypermagnesemia is considered to be very rare [1]; it is usually caused by a laxative overdose, and it may occur in patients with kidney dysfunction. There was no obstruction, and minimal tumor at the rectum by colonoscopy, and his nodes had decreased by CT scan He was admitted to undergo a laparoscopic abdominoperineal resection, and, for mechanical bowel preparation (MBP), he received 34 g of magnesium citrate (Magcorol P®; containing 2.71 g of magnesium (Mg)) orally at 2:00 PM, day 0. Emergency CT and abdominal X-ray examinations revealed diffuse and marked dilatation of the large-bowel loops, with fecal impaction 6 cm in diameter at the sigmoid colon (Fig. 1), and no free air in the abdominal cavity. His head CT scan was of normal finding, as was his echocardiography findings.

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