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  1. Accutane and the Potential for Increased Risk of Crohn’s Disease and Ulcerative Colitis

    Posted by Dr. Jack Sacks, Esq.on December 31, 2010

    Accutane has been prescribed since the 1980’s to treat severe acne.  Since then, thousands of patients have reported serious side effects that include gastrointestinal disorders. The American Journal of Gastroenterology reported the connection in 2006, specifically noting the development of the inflammatory bowel diseases Crohn’s and ulcerative colitis in some Accutane users.

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    Crohn’s disease usually causes ulcerations and bowel wall swelling in areas throughout the length of the small and large intestine.  Crohn’s disease can spare the rectum, but often causes inflammation or infection with drainage around the rectum.  Ulcerative colitis usually causes ulcers in the lower part of the large intestine, often starting at the rectum.  However, it can involve the entire large intestine and extend into the small intestine (see www.familydoctor.org).

    The FDA requested that Hoffman-La Roche change their label for Accutane to warn that the drug has been associated with the development of inflammatory bowel disease in patients without a prior history of intestinal disorders.  These inflammatory bowel diseases have been reported to persist after Accutane treatment has been stopped. In 2009, Swiss based Roche Holding recalled Accutane from the market due to evidence that the drug was linked to the potential development of inflammatory bowel disease.


  2. Hirschsprung’s Disease and Medical Malpractice

    Posted by Dr. Jack Sacks, Esq.on December 29, 2010

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    Hirschsprung’s Disease is a congenital disorder of the large intestine that occurs in about one in five thousand births. Unfortunately, this disease is responsible for twenty-five percent of all intestinal blockages in newborns. Suspected signs and symptoms in a newborn include constipation, abdominal distension, projectile vomiting, poor feeding, and a failure to pass meconium within forty-eight hours after birth. Physiologically, the affected segment of the large intestine narrows because of the absence of local ganglion nerve cells which function to prevent bowel contraction. In long segment HD, more of the large intestine is affected (than in short segment HD) with as much as thirty centimeters of the bowel contracted.  Although the affected area of the large intestine is contracted, the preceding area of the large intestine is enlarged due to the backup of bowel contents which is why patients present with a distended abdomen.

    Pediatricians and pediatric gastroenterologists report that normal breast-fed newborns have approximately four to five bowel movements a day and formula fed newborns will have two to three bowel movements a day. In Hirchsprung’s patients, the number of bowel movements is significantly diminished as a result of the constipation caused by the narrowing of the bowel. At six months of age, most normal newborns have two bowel movements per day; however, this number is typically less for Hirschsprung’s patients of the same age.

    Without proper diagnosis and treatment, Hirschsprung’s patients are at risk for intestinal rupture or perforation that can cause death. Methods of diagnosis include a rectal suction biopsy, or a full thickness biopsy which is generally definitive. Other techniques that may indicate the presence of Hirchsprung’s disease include anorectal manometry and barium enema. There are various surgical techniques available to treat severe Hirschsprung’s disease. Corrective surgery to the large intestine is performed in two phases. The first phase involves a colostomy and is usually performed early in life. Years later, the second surgical phase is performed which is a pull-through procedure where the large intestine is reconnected to the anus. There are several different types of pull-through procedures that are well established, with the transanal pull-through procedure gaining popularity. High fiber diets and frequent enemas help to alleviate symptoms of constipation associated with Hirschsprung’s disease.

    Medical malpractice may arise when there is a failure to diagnose Hirschsprung’s disease that results in death or serious permanent injury. Allegations may include a failure to timely refer the patient to a pediatric gastroenterologist or surgeon, or a failure to order or perform proper diagnostic testing or biopsy.

    For a complete overview on the diagnosis and treatment of Hirschsprung’s disease, please see the 3rd edition of Hirschsprung’s Disease and Allied Disorders by A.M Holschneider and P. Puri which became available in paperback in 2010. For families who have a loved one afflicted with Hirschsprung’s disease, there is a support group called the Hirschsprungs & Motility Disorders Support Network .