背景:Naldemedine是一种口服可用的外周作用μ-阿片受体拮抗剂,被批准用于治疗阿片样物质诱导的便秘(OIC)。对于已知或疑似胃肠道梗阻的患者,禁忌防止纳地米定引起的穿孔。这里,我们报道了一例疑似乙状结肠憩室穿孔与纳地米定相关的临床病例。
方法:患者是一名65岁的男性,有口腔癌病史,曾服用羟考酮(20mg/天)治疗癌症疼痛。在第0天,患者在OIC的就寝时间前每天一次开始使用纳地米定0.2mg。对于疼痛控制,羟考酮的剂量增加至60mg/天。在Naldemedine治疗的第35天,患者出现发热和腹痛,他的排便频率减少了。最初的实验室结果显示C反应蛋白(CRP)水平为28.5mg/dL,白细胞(WBC)计数为13,500/µL。在第37天,患者的下腹部仍然有压痛。腹部计算机断层扫描显示腹腔中有游离空气,提示肠穿孔。进行了Hartmann程序。组织病理学发现乙状结肠有许多憩室,其中一些是穿孔的。
结论:这些结果表明,OIC的作用可能会压缩肠道,随后是纳达米定激活蠕动,导致肠穿孔的发作。在先前存在憩室疾病的患者中,我们应该监测Naldemedine开始治疗后WBC计数和CRP水平的增加,并考虑在腹部不适的情况下尽早进行适当的检查。
BACKGROUND: Naldemedine is an orally available peripherally acting μ-opioid receptor antagonist approved to treat opioid-induced constipation (OIC). It is contraindicated for patients with known or suspected gastrointestinal obstruction to protect against naldemedine-induced perforation. Here, we report a clinical case of suspected perforation of a
diverticulum in the sigmoid colon associated with naldemedine.
METHODS: The patient was a 65-year-old man with a history of oral cancer who had been prescribed oxycodone (20 mg/day) for cancer pain. On day 0, the patient started naldemedine 0.2 mg once daily before bedtime for OIC. The dose of oxycodone was increased for pain control up to 60 mg/day. On day 35 of naldemedine treatment, the patient developed fever and abdominal pain, and his frequency of defecation had decreased. Initial laboratory results showed a C-reactive protein (CRP) level of 28.5 mg/dL and white blood cell (WBC) count of 13,500/µL. On day 37, the patient still had tenderness in his lower abdomen. Abdominal computed tomography revealed free air in the abdominal cavity suggesting an intestinal perforation. A Hartmann procedure was performed. Histopathological findings showed numerous diverticula in the sigmoid colon, some of which were perforated.
CONCLUSIONS: These results suggest that the effects of OIC may have compressed the intestinal tract, which was followed by naldemedine-activation of peristalsis, which led to the onset of intestinal perforation. In patients with pre-existing diverticular disease, we should monitor for increased WBC counts and CRP levels after the initiation of treatment with naldemedine, and consider performing appropriate tests early in the event of abdominal complaints.