Acute Colonic Pseudo-Obstruction Caused by Dexmedetomidine: A Case Report and Literature Review

Abstract

Patient: Male, 50Final Diagnosis: Acute colonic pseudo-obstructionSymptoms: Abdominal pain • cough • feverMedication: —Clinical Procedure: Colonoscopy decompression and colectomySpecialty: Critical Care MedicineObjective:Rare co-existance of disease or pathologyBackground:Acute colonic pseudo-obstruction (ACPO) is an infrequent entity characterized by non-toxic, non-mechanical, abrupt, functional dilation of the colon. Clinically patients present with abdominal distention, anxiety, severe abdominal pain, nausea, and vomiting. This rare entity can lead to a fatal outcome if not recognized early. A high level of suspicions is paramount for early diagnosis and prompt intervention.Case Report:A 50-year-old male was admitted to the intensive unit care due to acute hypoxic respiratory failure, pneumonia, and septic shock requiring mechanical ventilation and intravenous vasopressors. Two weeks after admission, his clinical course deteriorated and was complicated with acute abdominal distension, pain, and ileus. Imaging confirmed acute onset of ileus and after ruling out metabolic and infectious causes, the diagnosis of ACPO was made. Aggressive medical and surgical management resulted in a favorable outcome.Conclusions:Critically ill patients on ventilator are commonly sedated; therefore, usual symptoms of ACPO can be missed or misinterpreted leading to late diagnosis with increased morbidity and mortality. Clinicians must be aware of potential harm and side effects from common sedatives used in the intensive care unit and should be current on medical literature. Alpha-2 agonists, i.e., dexmedetomidine, is increasingly been used in critical care setting and there are few reports of a possible association with ACPO. We present here a case of a patient with dexmedetomidine-induced ACPO, and we provide a review of the existing literature and pathophysiology of the condition.

Reconstruction Algorithm-Based Ultrasonic and Spiral CT Images in Evaluating the Effects of Dexmedetomidine Anesthesia for Acute Abdomen

“…Ultrasonic acquisition equipment has developed from mechanical scanning to electronic scanning and from one-dimensional probes to two-dimensional array probes. However, a large amount of ultrasound data obtained cannot be used [ 11 ]. In this context, 3D reconstruction technology emerged and became a hot spot in current research.…”

Acute Colonic Pseudo-Obstruction Following the Use of Dexmedetomidine

“…In 2019, Pérez-Lara et al reported a similar case of dexmedetomidine-induced ACPO [ 19 ]. Awareness of that report leads to early suspicion that dexmedetomidine might be the culprit, primarily when the second exposure was associated with increased NG tube output.…”

Ogilvie’s-Syndrome: A Rare but Real Postpartum Nightmare

“…Whereas obstetric causes included cesarean (the most common), obstetric hemorrhage, multiple pregnancies, and preterm labor. Some medications are found to cause ACPO as narcotics, tricyclic antidepressant, antiparkinsonian drugs, Syntocinon and Dexmedetomidine [8,9].…”

“…Therefore, symptoms of ACPO are usually missed resulting in late diagnosis with increased morbidity and mortality. There are few reports of a potential association with ACPO [9,25].…”