A Case of Neostigmine Trial in Acute Colonic Pseudo-obstruction

Kim, Wan Su; Han, Sang Young; Bae, Yee Zee; Jang, Jin Seok; Chung, Je Hyuk; Lee, Jong Hoon; Roh, Myung Hwan; Choi, Seok Ryeol; Shin, Woo Won

Abstract

Acute colonic pseudo-obstruction (ACPO) known as Ogilvie's syndrome is characterized by massive dilatation of the colon without a mechanical obstruction with unclear pathophysiology. The ACPO is associated with wide variety of medical and surgical conditions, especially pregnancy, cesarean section, and trauma. Usually, the conservative therapy of 2-3 days is enough for its treatment. However, if it shows no effect, colonoscopic decompression is recommended. As an alternative, neostigmine has been reported to be effective in the treatment of ACPO. Here, we report a case of idiopathic ACPO treated with neostigmine. The initial treatment was conservative but showed no effect, and thus colonoscopic decompression was followed. After decompression, symptoms improved. However, 10 days after decompression, abdominal distension recurred. Thus, we injected 2.0 mg of neostigmine intravenously for 3 minutes. It improved the symptom. Seven days later, the symptoms were aggravated, so 1.0 mg of neostigmine was administrated twice, which did not work. The patient was transferred for exploration, and a total colectomy was carried out. Sever days after colectomy, the patient died of sepsis.