Perforation of gastric volvulus within a giant hiatus hernia secondary to alendronate: A rare complication of bisphosphonate use. (2020)

• Record Type: Journal Article
• Authors: Kwan, Bianca; Wong, Jason
• Is Part Of: International journal of surgery case reports. Volume 73(2020)
• Page Start: 5
• Page End: 8
• Publication Date: 2020
• Subjects: Alendronate -- Bisphosphonates -- Massive hiatus hernia -- Perforated gastric volvulus -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.06.068
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: A case of perforation due to alendronate in patient with gastric volvulus within giant hiatus hernia. Bisphosphonates can have devastating gastrointestinal side effects. Gastric or oesophageal perforation due to bisphosphonates is rare but serious. Bisphosphonates should be avoided in those with functional or anatomical disorders of the gastrointestinal tract. Abstract: Introduction: Bisphosphonates are commonly used in the treatment of metabolic bone disease. However, they are associated with gastrointestinal side effects including acid reflux, mucosal erosion, and oesophageal stricture. We present a rare case of alendronate causing perforated gastric volvulus in a patient with giant hiatus hernia. Presentation of case: An 82-year-old woman presented to our hospital with central chest pain, palpitations and new onset atrial fibrillation on the background of 2 weeks of vomiting. Computed tomography (CT) imaging revealed a perforated, mixed type organoaxial/mesoenteroaxial gastric volvulus within a giant hiatus hernia, with partial gastric outlet obstruction. The patient underwent laparoscopic reduction of hiatus hernia and gastric volvulus, conversion to laparotomy, and distal gastrectomy with Bilroth II reconstruction. An alendronate tablet was found in the right mediastinum. The patient had a prolonged post-operative course and was discharged home after completing extensive physical rehabilitation. Discussion: Bisphosphonates are widely used to treat metabolic bone disease, however can have devastating adverse effects on the gastrointestinal tract. There are a number of mechanisms postulated for how these medications cause injury to the gastric and oesophageal mucosa. Conclusion: This case illustrates the importance of considering the gastrointestinal effects associated with bisphosphonates when prescribing them to patients, especially those with functional or anatomical disorders of the gastrointestinal tract. The presence of a large hiatus hernia should be a contraindication to prescribing alendronate.