Acute Ileus From Steroid Withdrawal Simulating Intestinal Obstruction After Surgery for Ulcerative Colitis

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Abstract
• Sixty of 127 prednisone-dependent patients with ulcerative colitis who underwent colectomy and endorectal ileal pullthrough with ileal reservoir and subsequent laparotomy with ileostomy closure (254 operations) during a 4-year period developed 95 episodes of intestinal obstruction during the early postoperative period. Acute ileus due to steroid withdrawal caused symptoms of intestinal obstruction in 43 patients (76 episodes), whereas true mechanical small-bowel obstruction occurred in only 17 patients (19 episodes). Symptoms of both conditions were similar; however, hypoactive bowel sounds, acute onset of emotional depression, no evidence of obstruction on radiologiccontrast stomatogram or enema, and prompt relief of symptoms within 4 hours after intravenous administration of hydrocortisone acetate distinguished acute steroid withdrawal. Since ileus from acute steroid withdrawal occurred four times as frequently as mechanical small-bowel obstruction, prompt recognition and treatment should appreciably reduce postoperative morbidity and hospital costs. (Arch Surg. 1990;125:914-917)