Use of neostigmine to relieve a suspected colonic pseudoobstruction in pregnancy

Rausch, M E; Troiano, Nan H.; Rosen, Todd

doi:10.1038/sj.jp.7211669

Cited by 11 publications

(10 citation statements)

References 8 publications

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“…The fetus therefore should be monitored continuously, and the obstetric team can proceed immediately to delivery by cesarean if indicated. 11 When neostigmine management fails or is contraindicated, colonic decompression should be done to decrease the risks of ischemia and perforation. Decompression generally is recommended when the colon is dilated more than 12 cm.…”

Section: How Is Ogilvie Syndrome Diagnosed? Does This Change In Pregnmentioning

confidence: 99%

“…The estimated fetal exposure of a lower gastrointestinal series is 2-4 rads; it should be used carefully during pregnancy, especially because various radiographic studies have suggested that 5 rads is the safe upper limit for fetal exposure. 11 There are two critical diseases that present like Ogilvie syndrome: mechanical colonic obstruction and toxic megacolon. Mechanical colonic obstruction may be caused by sigmoid volvulus, tumors, benign stricture, or fecal impaction; toxic megacolon may be caused by infection.…”

Section: How Is Ogilvie Syndrome Diagnosed? Does This Change In Pregnmentioning

confidence: 99%

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Constipation During Pregnancy

Kim

Lee

Chung

2012

Obstetrics & Gynecology

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A 23-year-old primigravid woman at 14 1/7 weeks of gestation arrived at the emergency department with abdominal pain. Two months earlier, she began having intermittent pain and constipation. She had performed an enema three times and had received intermittent medicated laxatives for 2 months from local clinics. The patient reported having had severe constipation for 7 days 1 year perviously. Her past medical, surgical and family histories were negative. On physical examination, she was 155 cm tall and weighed 38 kg. She had diffuse abdominal tenderness without rebound tenderness. Her bowel sounds were normal. She displayed intermittent colicky pain, which subsided only with opioid treatment. She was treated with stool softeners and laxatives.One day after admission, the patient's hemoglobin was 9.7 g/dL, hematocrit was 27.1%, and white blood cell count was 9,840/microliter. We prescribed rehydration, electrolyte control, and analgesics for intermittent severe pain. Three days after admission, she developed night fevers (maximum temperature 38°C) and sweating. Considering our differential diagnosis, which included infection and connective tissue disorder, we ordered various other laboratory studies including erythrocyte sedimentation rate; urine culture; hepatitis A, B, and C evaluation; antinuclear antibody testing; and rheumatic factor; all were within normal limits. The C-reactive protein level was elevated to 3.40 mg/dL. We began cefotetan intravenously 4 days after admission; the physician recommended she receive nothing by mouth. Six days after admission, a magnetic resonance imaging scan revealed marked dilatation (6-cm diameter) of the transverse and descending colon (Fig. 1).Seven days after admission, glutamyl oxaloacetic transaminase and glutamyl pyruvic transaminase levels increased to 102 and 134, respectively.Eight days after admission, the C-reactive protein level increased to 11.73 mg/dL, and upper endoscopy revealed gastritis. Colonoscopy revealed multiple colon ulcers, colonic atony, and colonic inertia (Fig. 2). The physician and patient agreed to radiologic studies to evaluate possible colon perforation. An X-ray computed tomography scan revealed a sigmoid colon collapse with fecal content; the transverse colon was 10 cm in diameter, and the colon was dilatated from the cecum to the transverse colon (Fig. 3). No perforation was seen. Ogilvie syndrome (acute colonic pseudo-obstruction) then was suspected. Nine days after admission, we performed a diatrizoate meglumine and diatrizoate sodium (Gastrografin) enema. Rectal and nasogastric tubes were placed for decompression, and erythromycin, piperacillin, and tazobactam were given intravenously. (We did not prescribe neostigmine because it is contraindicated in a setting of gastrointestinal ulcers.) The

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Section: How Is Ogilvie Syndrome Diagnosed? Does This Change In Pregnmentioning

confidence: 99%

Section: How Is Ogilvie Syndrome Diagnosed? Does This Change In Pregnmentioning

confidence: 99%

Constipation During Pregnancy

Kim

Lee

Chung

2012

Obstetrics & Gynecology

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“…In addition, atropine should be available at the bedside and patients should receive continuous electrocardiographic monitoring with vital sign for 30 minutes. The use of neostigmine in pregnancy has not been well-studied (6). The rate of recurrence of acute colonic pseudo-obstruction after neostigmine ranges from 5 to 33% (7).…”

Section: Correct! 2 Neostigmine An Acetylcholinesterase Inhibitor mentioning

confidence: 99%

September 2014 critical care case of the month: bad case of colic

Andrews¹,

Almasri²

2014

Southwest J Pulm Crit Care

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History of Present Illness: A 70 year old man with a past medical history of chronic kidney disease, bipolar disorder, benign prostatic hypertrophy, hypertension and diabetes presented to the emergency department with constipation associated with bloating for 15 days. He denies flatus. He tried over the counter laxatives (polyethylene glycol) with no relief. He has no recent history of colonoscopy or recent antibiotic use. He denies chills, diarrhea, dysuria, fever, hematochezia, hematuria, melena, nausea or vomiting. In the emergency department, he is tachypneic with a grossly distended abdomen.

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“…Sir William Heneage hat das Ogilvie-Syndrom 1948 erstmals bei 2 Patienten beschrieben [6]. Insgesamt werden mehrere kasuistische Fälle des Ogilvie-Syndroms nach Sectio caesarea in der Literatur beschrieben [1,3,8,12,13] Abb. 4 a, b).…”

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“…Aber auch die Schwangerschaft allgemein [6], ein begleitendes HELLP-Syndrom [7], Mehrlingsschwangerschaften mit einem fetofetalen Transfusionssyndrom [9] und die normale vaginale Entbindung können zu einem Ogilvie-Syndrom führen [10]. Insgesamt werden in der Literatur nur 5 Fälle mit akuter Pseudoobstruktion während der Schwangerschaft berichtet [9,13]. Die meistvertretene Hypothese ist die, dass eine Imbalance im autonomen Nervensystem die Ursache des ACPO ist [2,3,5,9,11].…”

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Akute Pseudoobstruktion des Kolons (Ogilvie-Syndrom), eine seltene und ernste Komplikation nach Sectio caesarea

Müller-Aufdemkamp¹,

Huber²,

Wolfrum-Ristau³

et al. 2011

Geburtsh Frauenheilk

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Das Ogilvie-Syndrom (akute Pseudoobstruktion des Kolons) ist eine seltene und ernste Komplikation nach Sectio caesarea und anderen abdominalen Eingriffen mit einer Letalität von 15-20 %. Bei einer assoziierten Ischämie oder Perforation beträgt die Letalität 36-50%. Die Datenlage zur Prä-valenz ist unsicher. Es wird geschätzt, dass das Ogilvie-Syndrom zu 0,1 % nach chirurgischen Eingriffen, zu 0,05 % bei Patienten mit einem Trauma und zu 0,3 % bei Patienten mit schweren Verbrennungen vorkommt. Es ist durch ein adynamisches, nicht obstruiertes Kolon gekennzeichnet, mit rascher Progression der Dilatation des Zäkums, rechten Hemikolons und Colon transversum. In der Literatur werden einige kasuistische Fälle des Ogilvie-Syndroms nach Sectio caesarea beschrieben. Bei der Ätiologie und Pathogenese herrscht weitgehend Uneinigkeit. Es werden jedoch prä-disponierende Faktoren diskutiert wie urologische, gynäkologische und orthopädische Eingriffe im Abdomen, Traumata im Retroperitonealraum, Sepsis, virale Infektionen und metabolische Faktoren, die zu einer Imbalance des autonomen Nervensystems führen. Die am besten dokumentierte Therapie des ACPO ist die intravenöse Gabe von Neostigmin. Der Erfolg konservativer Maßnah-men wird mit 20 bis 90 % beschrieben. Ab einer Dilatation des Kolons über 12 cm Länge und bei Progression des Krankheitsbilds ist eine rasche koloskopische Dekompression bzw. eine chirurgische Intervention erforderlich. Auch wenn das Ogilvie-Syndrom selten nach gynäkologischen und geburtshilflichen Eingriffen auftritt, ist es für Gynäkologen wichtig, Symptome möglichst früh zu erkennen und schnell zu intervenieren, um gefürchtete Komplikationen wie Ischämie oder Perforation zu verhindern. Im Folgenden wird über eine Patientin mit Ogilvie-Syndrom nach Sectio caesarea berichtet. Es werden Symptome, diagnostische Maßnahmen und Therapiemöglichkei-Abstract ! Ogilvieʼs syndrome (acute colonic pseudo-obstruction) is a rare and serious complication which can occur after Caesarean section and other surgical interventions. Ogilvieʼs syndrome has a mortality rate of 15-20 %. If ischemia or bowl perforation develops, the mortality rate increases to 36-50 %. The estimated incidence of Ogilvieʼs syndrome is 0.1 % after surgical procedures, 0.05 % in trauma patients and 0.3 % in patients with severe burns. Ogilvieʼs syndrome is characterised by acute colonic dilatation in an adynamic colon in the absence of obvious colonic disease or mechanical obstruction. Only a few cases of Ogilvieʼs syndrome after Caesarean section have been described in the literature to date. The etiology and pathogenesis of Ogilvieʼs syndrome are still unclear, but it has been associated with predisposing factors such as intraabdominal surgery, retroperitoneal trauma, sepsis, viral infections and metabolic imbalance, any of which may lead to a disturbance in the autonomic innervation of the colon. The best documented treatment for Ogilvieʼs syndrome consists of intravenous administration of neostigmine. Colonoscopic decompression is urgent if caecal d...

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Use of neostigmine to relieve a suspected colonic pseudoobstruction in pregnancy

Cited by 11 publications

References 8 publications

Constipation During Pregnancy

Constipation During Pregnancy

September 2014 critical care case of the month: bad case of colic

Akute Pseudoobstruktion des Kolons (Ogilvie-Syndrom), eine seltene und ernste Komplikation nach Sectio caesarea

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