Treatment of acute colonic pseudo-obstruction with neostigmine.
BACKGROUND
Colonic pseudo-obstruction is a poorly understood syndrome, described by Ogilvie, and characterized by signs of large-bowel obstruction, without a mechanical cause. An imbalance in the autonomic nerve supply to the colon has been suggested as the pathophysiology. Recently, promising results with pharmacologic manipulation with neostigmine have been described.


METHODS
A prospective study was undertaken with 11 consecutive patients with clinical and radiologic signs of colonic pseudo-obstruction, in one general hospital, over a 1-year period. Patients were treated primarily with 2.5 mg of neostigmine in 100 mL of saline for 1 hour, under cardiac monitoring. Results were assessed by the clinical and radiologic responses.


RESULTS
Rapid and effective spontaneous decompression of the colon was achieved in 8 patients after a single dose of neostigmine, within a mean of 90 minutes from the beginning of treatment. In another two patients decompression occurred only after a second dose was administered 3 hours after the first dose. In one patient, no changes were observed and colonoscopic decompression was performed. No significant bradycardia was observed in any of the patients.


CONCLUSIONS
Neostigmine is a simple, safe, and effective therapy for treatment of colonic pseudo-obstruction.
Paran
H
H
Department of Surgery A, Meir General Hospital, Kfar-Sava, Israel.
Silverberg
D
D
Mayo
A
A
Shwartz
I
I
Neufeld
D
D
Freund
U
U
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003112:Colonic Pseudo-Obstruction / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use*; D010277:Parasympathomimetics / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome
D010277:Parasympathomimetics; D009388:Neostigmine