Abstract
A 50-year-old woman underwent total abdominal hysterectomy and bilateral salphingo-oophorectomy for heavy menstrual bleeding due to a uterine fibroid. On second post-operative day she developed progressive abdominal distention, tachycardia, and fever. An intra-abdominal pathology was suspected and she was re-opened on the third postoperativeday. At laparotomy a distended colon was found with serosal tears due to distention with no distal colonic obstruction. Bowel decompression was done and a diagnosis of acute colonic pseudo-obstruction (ACPO) was made. Since her abdominal distention was persisting after the laparotomy she was treated with intravenous neostigmine. She responded immediately with passage of flatus and bowel opening. Subsequent recovery was uneventful. ACPO is a clinical entity characterized by severe colonic distention in the absence of mechanical obstruction. It can result in bowel ischaemia and perforation if left untreated. Therapeutic importance of neostigmine is discussed in the management ofthis potentially fatal condition.
Highlights
Ogilvie’s syndrome describes an acute colonic pseudoobstruction (ACPO) consisting of dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction
Here we describe a patient who developed acute colonic pseudo-obstruction following total abdominal hysterectomy with no co-morbid factors
Acute colonic pseudo-obstruction (ACPO) is a clinical entity characterized by severe colonic distention in the absence of mechanical obstruction[2]
Summary
Ogilvie’s syndrome describes an acute colonic pseudoobstruction (ACPO) consisting of dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction Here we describe a patient who developed acute colonic pseudo-obstruction following total abdominal hysterectomy with no co-morbid factors. On examination she was afebrile, not pale with a pulse rate of 88 bpm, blood pressure 120/80mmHg. Patient was kept on clear fluids and analgesics were given for the pain relief. Twenty-four hours after the laparotomy, tachycardia was persisting >120 bpm with ongoing fever spikes and intra abdominal pressure was gradually rising up to 16mmHg. Full blood count showed WBC of 17 × 103 with neutrophil leukocytosis, CRP 284, serum electrolytes and creatinine were within normal range. Patient was transferred back to ward and discharged after a good recovery on day 7 of laparotomy
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