Assessment of Predictors of Response to Neostigmine for Acute Colonic Pseudo-Obstruction

Loftus, Conor G.; Harewood, Gavin C.; Baron, Todd H.

doi:10.1111/j.1572-0241.2002.07108.x

Cited by 91 publications

(56 citation statements)

References 19 publications

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“…Success rates as high as 96 per cent have been achieved with conservative measures [12], but poorer results have been reported [13]. Medical managements include drugs like metoclopramide and neostigmine.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

2016

J Syndr

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Acute colonic pseudo obstruction (ACPO), also known as Ogilvie's syndrome is a very rare postoperative complication of Caesarean section. It has classically been reported in critically ill patients and following cardiac and hip surgery. Whether this complication recurs in subsequent operations is not known. Only one case report of recurrence following caesarean section was found in literature survey. We report a case of Ogilvie's syndrome which recurred in the second Caesarean section and was successfully managed conservatively. IntroductionOgilvie's syndrome or acute colonic pseudo obstruction (ACPO) is a rare but potentially fatal postoperative complication which is characterised by severe adynamic ileus with massive colonic dilatation in the absence of mechanical obstruction. Sir William Heneage Ogilvie described this syndrome in 1948 which was subsequently named after him. It has an incidence of 0.1% approximately following major surgeries [1] like cardiac and hip surgery [2,3]. In women, caesarean section appears to be the most common surgery associated with Ogilvie's syndrome [4].We report a case of recurrent Ogilvie's syndrome in two consecutive Caesarean sections in a patient with severe pre-eclampsia. On both occasions she was successfully managed conservatively. This case is unique because it seems to be the second such reported case of post cesarean section recurrent Ogilvie's syndrome (MEDLINE with search terms pseudo obstruction, post caesarean, and recurrence). Given the rising trend of caesarean sections, it is intuitive that this rare syndrome may not remain rare in the future. Obstetricians thus need to have awareness regarding the features, preventive measures and early recognition and management of this complication because patients may have to undergo cesarean sections in more than one occasions in her lifetime. Case PresentationA 33 years old P2+0 with 2 previous caesarean sections was referred to our hospital with gradual distension of abdomen from the 5 th postoperative day of Caesarean section. She had no stool since operation but was passing flatus without any vomiting or fever. She had undergone emergency Caesarean section under spinal anaesthesia in a peripheral health unit for severe pre-eclampsia in a post caesarean pregnancy.The operative notes in the referral card mentioned that she Case Report Open Access Journal of Syndromeshad an episode of postpartum haemorrhage on the operation table which was managed by syntocinon drip, prostaglandin F2 ɑ (250 mcg I.M) and per rectal misoprostol (800 mcg). The estimated blood loss was around 1000 ml which was replaced with crystalloids and

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Section: Discussionmentioning

confidence: 99%

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

2016

J Syndr

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“…Although pregnant women were specifically excluded from this trial, there are retrospective data suggesting that women are more likely to be neostigmine responders. 3 Pharmacologic therapy would be a preferable, noninvasive option for pregnant women if safe and effective. The predominant cardiovascular effect of neostigmine is bradycardia and the patient must be monitored closely for cholinergic reactions.…”

Section: Commentmentioning

confidence: 99%

Use of neostigmine to relieve a suspected colonic pseudoobstruction in pregnancy

2007

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Neostigmine is a treatment option for colonic pseudoobstruction. However, experience in using neostigmine for this indication in pregnant women is limited. We present a case of a woman with an estimated fetal gestational age of 34 weeks presented with what was believed to be a pseudoobstruction and when conservative management failed, neostigmine was administered with no adverse side effects. Ultimately, the patient was found to have a mechanical obstruction and we discuss the challenges in making this diagnosis in pregnancy. Neostigmine may be a viable alternative to colonoscopy in pregnant women for whom mechanical obstruction is properly excluded.

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“…Patients with severe renal insufficiency may have an increased or prolonged vagomimetic response; thus, its use is contraindicated in such cases. 1,3,4,6 Acute kidney injury (AKI) may be exacerbated or develop because of the ACPO. 2,7,8 However, because neostigmine is contraindicated in renal insufficiency, there is no clinical data guiding the treatment of ACPO with AKI.…”

Section: Introductionmentioning

confidence: 99%

Effective and Safe Use of Neostigmine in Treatment of Acute Kidney Injury Associated with Colonic Pseudo-obstruction after Cardiac Surgery

Pyo

Rhee

2016

Korean J Gastroenterol

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Neostigmine can successfully decompress patients with acute colonic pseudo-obstruction (ACPO) who are unresponsive to conservative therapy. However, neostigmine is contraindicated in renal failure, so it is underused in ACPO patients with renal failure who would be otherwise appropriate candidates. We described the first successfully treated case of acute kidney injury (AKI) with neostigmine in a patient with ACPO. A 72-year-old man who underwent a coronary artery bypass graft surgery 11 days prior presented to the emergency room with abdominal distension, peripheral edema, and dyspnea on exertion. Plain abdominal radiographs and abdomen computed tomography scan showed diffuse colonic dilatation without obstruction. Serum creatinine level was increased five-fold over baseline. We diagnosed the patient as ACPO with AKI. With conservative treatment, renal function failed to improve because the ACPO was not corrected. Administration of neostigmine rapidly resolved ACPO and renal function, avoiding more invasive procedures such as colonoscopic decompression and hemodialysis. Neostigmine appears to be an effective and safe treatment option for ACPO patients with renal failure. Prospective large-scale studies should be carried out to determine the safety and efficacy of neostigmine in ACPO patients with renal failure. (Korean J Gastroenterol 2016;67:103-106)

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Assessment of Predictors of Response to Neostigmine for Acute Colonic Pseudo-Obstruction

Cited by 91 publications

References 19 publications

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

Use of neostigmine to relieve a suspected colonic pseudoobstruction in pregnancy

Effective and Safe Use of Neostigmine in Treatment of Acute Kidney Injury Associated with Colonic Pseudo-obstruction after Cardiac Surgery

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