Acute Colonic Pseudo-Obstruction: Rapid Correction with Neostigmine in the Emergency Department

Cholinergic interactions between donepezil and prucalopride in human colon: potential to treat severe intestinal dysmotility

“…These include post-operative ileus, intestinal pseudo-obstruction (Coulie and Camilleri, 1999), 'acute colonic pseudoobstruction' (Saunders, 2007) and 'megacolon ' (Bharucha and Phillips, 1999), collectively leading to significant individual morbidity and incident mortality (Coulie and Camilleri, 1999). Cholinesterase inhibitors such as neostigmine or pyridostigmine are sometimes used to enhance intestinal propulsion in patients with severe hypomotility (Law et al, 2001), especially those with acute colonic pseudo-obstruction in which dilatation of the colon can lead to perforation and death (Turégano-Fuentes et al, 1997;Ponec et al, 1999;Amaro and Rogers, 2000;Trevisani et al, 2000;Loftus et al, 2002;Mehta et al, 2006;Saunders, 2007;McNamara and Mihalakis, 2008;O'Dea et al, 2010;Elsner et al, 2012;Bharucha et al, 2013). The latter can occur in patients of any age after major surgery or trauma, severe illness or during intensive care (Saunders and Kimmey, 2005;Saunders, 2007;Giorgio and Knowles, 2009).…”

“…However, it most commonly occurs in susceptible elderly patients with extensive co-morbidities (Hyatt, 1987), in whom neostigmine and pyridostigmine may be absolutely contraindicated or hazardous due to cardio-bronchial side effects or renal insufficiency (Saunders, 2007). Further, neostigmine is an unattractive treatment option in any patient due to side effects of abdominal pain, excess salivation, nausea and/or vomiting, bradycardia (necessitating cardiac monitoring; Saunders, 2007;McNamara and Mihalakis, 2008), hypotension and bronchospasm (Turégano-Fuentes et al, 1997;Amaro and Rogers, 2000). For these reasons, the use of cholinesterase inhibitors beyond acute colonic pseudo-obstruction has been limited to anecdotal reports of patients with cancer and opioid-induced chronic constipation (Rubiales et al, 2006;Papa and Turconi, 2010), chronic constipation associated with spinal injury (Singal et al, 2006;Ebert, 2012) and patients with autonomic neuropathies (Bharucha et al, 2008).…”

An Unusual Case of Ogilvie Syndrome in a Pediatric Oncology Patient Receiving Palliative Care after Failed Treatment with Neostigmine

“…Numerous case reports have documented its successful use, including in emergency departments and with pediatric patients. 8,9,[11][12][13] In a larger series, 26 of 28 patients showed clinical resolution of Ogilvie syndrome after treatment with neostigmine. 14 The drug has a half-life of approximately 1 hour, and case reports suggest patients refractory to bolus dosing may respond to continuous neostigmine, possibly due to a prolonged period of sustained peristalsis.…”

Ogilvie Syndrome and Herpes Zoster: Case Report and Review of the Literature

“…The treatment of colonic pseudo-obstruction associated with herpes zoster does not differ from the established approach to Ogilvie syndrome caused by another condition. The published emergency medicine literature recommends initial conservative management, including observation, nasogastric tube suctioning, intravenous hydration, electrolyte correction, discontinuing precipitating medications when possible, placement of a rectal tube, ambulation, or frequent patient repositioning (27,28). Conservative management is continued for 72 h, provided the cecal diameter is Ͻ 12 cm and there is no evidence of bowel ischemia or perforation; this approach is successful in up to 75% of the patients (28).…”