Acute Abdomen with Ileus: A Heralding Presentation of Neuroleptic Malignant Syndrome

Abstract

The pathophysiology of neuroleptic malignant syndrome (NMS) with use of psychotropic drugs is still unclear. Although a rare event with an incidence of 0.02–3.2%, when not promptly recognized and managed, it carries a high mortality (10–20%) and morbidity rate. Presentation can be either typical, with muscle rigidity and hyperpyrexia, or atypical, the latter posing diagnostic and early management challenges in clinical practice. Our patient presented with delayed fever and ileus, making early diagnosis difficult. We propose that NMS be considered an alternate diagnosis in patients using psychotropic medications and manifest ileus and delayed fever, especially after other differentials have been excluded.

Application of Laparoscopy Combined with Enhanced Recovery after Surgery (ERAS) in Acute Intestinal Obstruction and Analysis of Prognostic Factors: A Retrospective Cohort Study

“…The more common causes of acute intestinal obstruction include abdominal adhesions, tumors, and hernias [ 3 ]. One of the most common is abdominal adhesion, and abdominal adhesion induced by previous abdominal surgery is the main cause of small intestinal obstruction (SBO), accounting for 60% of the number of cases [ 7 ]; appendix, colorectal, hernia, and other lower abdominal surgery and gynecological pelvic surgery greatly increase the risk of adhesive SBO [ 8 ]. The clinical manifestations are typical abdominal pain, nausea, vomiting, abdominal distension, and cessation of exhaust and defecation [ 2 ].…”

Neuroleptic malignant syndrome in fields other than psychiatry

“…develops after administering drugs that block the dopamine receptor. 3,[17][18][19][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]44,46,49,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][66][67][68][69] However, most patients who were administrated bromocriptine, which acts as a dopamine antagonist, showed an improvement in NMS symptoms. [17][18][19]22,24,26,…”

“…Dopamine receptor blockade in the nigrostriatal pathway or hypothalamus may cause NMS. According to many case reports, NMS develops after administering drugs that block the dopamine receptor 3,17–19,24–42,44,46,49,51–64,66–69 . However, most patients who were administrated bromocriptine, which acts as a dopamine antagonist, showed an improvement in NMS symptoms 17–19,22,24,26,28,31,36,39,41,46,48,53,55,67–69 .…”

“…Primary conditions in the first group ranged, widely, including trauma, 19,26,27,29,32,34,[40][41][42]52,57,58,64,75,81,83,86,88,89 digestive disease, 25,30,36,37,43,45,46,54,59,60,65,66,77,80,87 malignant tumor, 18,23,24,31,33,35,38,47,51,61,63 and cardiovascular disease 28,39,44,50,53,55,56,…”

“…We performed a review of NMS case reports from clinicians other than psychiatrists in English and Japanese literature. They could be classified into two groups: (1) cases in which NMS onset was triggered by administering causative drugs 17–19,22–89 and (2) cases in which NMS developed from disruption of regular medication (Tables 7 and 8). 8,16,90–114 An example of the former is a case in which antipsychotic drugs were administered for postoperative delirium; an example of the latter is a case in which regular medication (i.e., antipsychotic drugs) to treat schizophrenia was discontinued temporarily because of general anesthesia.…”