Post-colectomy depressive disorder: case report
DOI:
https://doi.org/10.25118/2763-9037.2025.v15.1483Keywords:
Colectomy;, Enterostomy, Depressive Disorder, Mental Health, Multidisciplinary TeamAbstract
Enterostomy is a surgical procedure indicated for various conditions, such as colorectal cancer, and consists of removing a portion of the intestine through the abdominal wall. Although it is an essential therapeutic approach, it has significant physical, social, and psychological repercussions, particularly in the development of depressive disorders. Study initiated upon signature of the Free and Informed Consent Form (FICF) by the patient and approval by the Research Ethics Committee of the Faculdade de Ciências Médicas e da Saúde PUC-SP, whose opinion number is 7,633,080 and CAAE is 88752825.5.0000.5373. The study aims to report the case of a patient diagnosed with ovarian cancer with intestinal metastasis, who underwent colectomy and colostomy and developed symptoms compatible with Depressive Disorder Due to Another Medical Condition, according to DSM-5-TR criteria. The temporal and causal correlation between the surgical procedure and the onset of symptoms, combined with discourse analysis, clinical progression, and risk factors, supports the diagnosis. Differential diagnoses, such as Posttraumatic Stress Disorder and Adjustment Disorder, were considered, but did not meet sufficient criteria. The patient's management included psychotherapy and pharmacotherapy with antidepressants, hampered by her refractoriness to first-line medications. The case illustrates the importance of understanding the various mechanisms involved in the pathophysiology, such as alterations in the intestinal microbiota, neuroinflammation, changes in quality of life, and difficulties with self-acceptance. It also highlights the need for monitoring by a multidisciplinary team and early interventions that promote mental health support for these patients, in order to minimize psychological distress and improve postoperative quality of life. Regular follow-up is also required to assess adverse effects of pharmacological therapy and deprescribe the drug at an appropriate time.
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