Creighton University School of Medicine Omaha, NE, United States
Syed M. Alam, MD1, Avanija Buddam, MBBS2, Erin Jenkins, MD1 1Creighton University School of Medicine, Omaha, NE; 2Creighton University, Omaha, NE
Introduction: Suprep is a low-volume bowel prep that is an efficacious alternative for patients undergoing screening colonoscopy. Side effects are minimal which is consistent with more common brand preps such as GoLytely. Cecal volvulus is defined by a loop of bowel that “twists” on itself around the cecum, suffocating the blood supply from the supportive mesentery. Here we present a case where a patient took a low-volume prep and developed cecal volvulus.
Case Description/Methods: A 59-year-old female with no significant past medical history started taking her low-volume prep the night before her routine screening colonoscopy. She subsequently began to have severe diffuse crampy abdomen pain with associated nausea that did not improve over time. She called the GI department and was instructed to report the ER if her symptoms didn’t improve with Tylenol. She decided to forgo colonoscopy the next day and go to the ER when her Tylenol didn’t improve her pain. CT scan in the ER showed cecal volvulus and she was promptly taken to the OR for reversal of her volvulus and right hemicolectomy with ileostomy was performed.
Discussion: Previous observational studies of common bowel preps show that Suprep is safer than traditional preps when checking for adverse events 3 months after administration. Among issues related adverse events included cardiac events (arrhythmia, ischemic complications), serious renal disease, and seizures. To the best of our knowledge, the potential of causing volvulus has not been reported in the literature. The development of volvulus shortly after ingestion of a low-volume prep is consistent with a prep-induced volvulus.
Low-volume prep has been used for patients who would like an alternative to traditional bowel preps in preparation for colonoscopy. Though they are generally well-tolerated, adverse events have been reported. Cecal volvulus could be a potential adverse outcome as observed in our patient, and further monitoring is recommended.
Figure: Image 1: Non-Contrast CT Abdomen at Presentation in the ER
Disclosures: Syed Alam indicated no relevant financial relationships. Avanija Buddam indicated no relevant financial relationships. Erin Jenkins indicated no relevant financial relationships.
Syed M. Alam, MD1, Avanija Buddam, MBBS2, Erin Jenkins, MD1. P2253 - Cecal Volvulus After Taking Low-Volume Prep, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.