LAUSR

An 84-year-old Japanese woman presented to the emergency department with a 1-day history of vomiting and right lower quadrant abdominal pain. She had been taking furosemide 80 mg/day and spironolactone 50 mg/day for generalized edema secondary to nephrotic syndrome. She had also received therapy for Alzheimer’s dementia. Two days earlier, medication dosage was increased; however, she became drowsy and had insufficient oral intake. A flat film of the abdomen showed significant gaseous distention in the left quadrant and calcification in the right upper quadrant (Figure 1). Non-enhanced computed tomography revealed calcification of the mesenteric veins and thickening of the wall of the ascending colon (Figure 2). A diagnosis of colonic obstruction due to phlebosclerotic colitis was made. At presentation, laboratory evaluation showed elevated serum creatinine and serum uric acid levels at 1.79 (range 0.4-0.7) mg/dl and 13.6 (range 2.3-7.0) mg/ dl, respectively. The symptoms disappeared within 2 days after the initiation of parenteral nutrition and discontinuation of diuretic therapy. Ten days later, her serum creatinine level normalized, and no edema was observed. Furthermore, the decreased dosage of psychotropic medications led to good awakening and recovery of the oral intake.