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

Abstract

This case highlights an infrequent, but important, gastrointestinal complication that can occur in pediatric patients with serious comorbid disease. Ogilvie syndrome should be included on the differential diagnosis list in pediatric patients with refractory constipation. Our case illustrates the progression of therapies, including surgical intervention that can be undertaken to treat this disorder in children and adults while providing important considerations for clinicians treating patients of any age with this unusual clinical complication.

Ogilvie syndrome in a 8 year old girl after laparoscopic appendectomy

“…It occurs primarily in adult patients, whereas it happens rarely in children. It has been suggested that it could be the result of suppression of sacral parasympathetic nerves’ activity together with an increase in sympathetic impulses, resulting in inhibition of colonic motility and hence in colonic dilatation [5, 6, 10]. Other pathogenetic theories include prostaglandin E abnormalities, decreased splanchnic perfusion, side effects of neurotropic medications, metabolic disorders affecting neuromuscular conduction (hypokalaemia, uremia) and herpes zoster virus reactivation [10].…”

“…The syndrome tends to occur in adult patients with serious medical and surgical conditions, as myocardial infarction, neoplasia, metabolic disorders, spinal injury, peritonitis, sepsis and shock. In pediatric population it has been described in oncology patients, especially when neutropenic and treated with high-dose vincristine [2–5] in patients who underwent spinal surgery [6], after administration of anticholinergic medication [11], in sickle cell disease [7], in Kawasaky disease [8], and after renal transplant [9].…”

“…The side effects of cholinesterase inhibitors include hypersalivation, nausea, vomiting, abdominal pain, bradycardia, hypotension and bronchospasm. During the infusion of neostigmine, patients should be monitored for possible development of bradycardia or bronchospasm [4, 5, 7, 14].…”

“…Ogilvie’s syndrome is a rare complication mostly described in adult patients with severe underlying medical or surgical conditions [1]. However, an increased number of cases of Ogilvie’s syndrome has been reported in children with oncological diseases [2–5], after spinal surgery [6], in sickle cell and Kawasaky disease [7, 8], and after renal transplant [9].…”