Blood Res.  2013 Jun;48(2):145-148. 10.5045/br.2013.48.2.145.

Acute colonic pseudo-obstruction following allogeneic stem cell transplantation successfully treated by neostigmine

• Yahng SA
• Yoon JH
• Shin SH
• Lee SE
• Eom KS
• Kim YJ

• KMID: 2172914
• DOI: http://doi.org/10.5045/br.2013.48.2.145

Abstract

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a rare clinical syndrome of massive large bowel dilatation without mechanical obstruction, which may cause significant morbidity and mortality. Treatment focuses on decompressing a severely dilated colon. The proposed theory that this severe ileus results from an imbalance in the autonomous regulation of colonic movement supports the rationale for using neostigmine, a reversible acetylcholinesterase inhibitor, in patients who failed conservative care. Although gastrointestinal complications are frequent following allogeneic stem cell transplantation (SCT), the incidence of ACPO in a transplant setting is unknown and, if not vigilant, this adynamic ileus can be underestimated. We describe the case of a patient with myelodysplastic syndrome undergoing non-myeloablative allogeneic SCT from a partially human leukocyte antigen-mismatched sibling donor, and whose clinical course was complicated by ACPO in the early post-engraftment period. The ileus was not associated with gut graft-versus-host disease or infectious colitis. After 3 days of conservative care, intravenous neostigmine (2 mg/day) was administered for 3 consecutive days. Symptoms and radiologic findings began to improve 72 hours after the initial injection of neostigmine, and complete response without any associated complications was achieved within a week. Thus, neostigmine can be a safe medical therapy with successful outcome for patients who develop ACPO following allogeneic SCT.

Keyword

Acute colonic pseudo-obstruction; Ogilvie's syndrome; Myelodysplastic syndrome; Allogeneic stem cell transplantation

MeSH Terms

Acetylcholinesterase
Colitis
Colon
Colonic Pseudo-Obstruction
Dilatation
Graft vs Host Disease
Humans
Ileus
Incidence
Leukocytes
Myelodysplastic Syndromes
Neostigmine
Siblings
Stem Cell Transplantation
Stem Cells
Tissue Donors
Transplants
Acetylcholinesterase
Neostigmine

Figure

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  Fig. 1 Plain abdominal radiograph on day +20 post-transplant reveals the presence of a dilated colon (A). A gaseous dilated transverse and ascending colon is shown on a computed tomography scan (B) obtained on the same day (day +20). There was no evidence of mechanical obstruction, bowel wall thickening, or abnormal enhancement. The blue lines indicate cecal diameter (C).

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  Fig. 2 Follow-up plain abdominal radiographs obtained on day +24, when neostigmine administration was initiated (A), and on day +30 show complete resolution of the colonic dilatation (B).

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