Nicorandil: A rare cause of recurrent ileal perforation

Introduction

Nicorandil is an antianginal drug whose link with oral and anal ulcers is well established. Through this case we hope to demonstrate that ulcers and perforations caused by nicorandil may also occur in the terminal ileum and may reoccur unless nicorandil is held. This is the first reported case of recurrent nicorandil induced perforations.

Case description

A seventy eight year old woman presented to hospital three times over a 4 months period with symptoms of an acute abdomen. On all three occasions she was found to have a perforation of the terminal ilium. She underwent laparotomies on the first two occasions with resection of a segment of the small bowel on the second. It was not until the third such event that her Nicorandil was implicated as the cause. This was duly stopped and she has been well since.

Conclusions

The likely hood of developing a GI ulcer is higher amongst nicorandil users. This occurrence is not just limited to the oral and anal regions but may occur all along the GI tract. Our case highlights nicorandil’s detrimental effects on the GI tract. It also suggests the early withdrawal Nicorandil as the optimum means of achieving remission.

Take home message

The authors propose that Nicorandil be withdrawn in cases of GI perforation to avert the risk a recurrence.