Abstract
Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report
Highlights
Prolonged (> 3-5 days) postoperative ileus can increase patient discomfort, prevent adequate nutrition, prolong hospitalization, and increase healthcare expenses[1]
In this report we present our experience with a case of refractory postoperative ileus that occurred in the context of an excessive catecholamine release
We report the case of a patient with an immediate-onset and prolonged postoperative ileus caused by an intense catecholamine release and resolved by the administration of Pyridostigmine, a reversible cholinesterase inhibitor
Summary
Prolonged (> 3-5 days) postoperative ileus can increase patient discomfort, prevent adequate nutrition, prolong hospitalization, and increase healthcare expenses[1]. Biochemical tests performed on POD 14 showed markedly elevated 24-hour urinary metanephrines [680 mcg (90-315)] and normetanephrines [1229 mcg (122-676)], as well as significantly increased plasma chromogranin A levels [2668 ng/ml (25140). A nasogastric tube was placed for gastric decompression and a subsequent abdominal Xray showed uniform dilatation of the small bowel loops suggestive of an immediate post-operative ileus (Figure 1). The tolerate oral intake, the patient was started on nasogastric tube was clamped for 1 hour after total parenteral nutrition on post-operative day each dose of Pyridostigmine to allow for its (POD) seven. After receiving a total of 3 doses of scan of the abdomen obtained on POD 12 ruled Pyridostigmine, the patient started passing flatus out a post-operative intestinal obstruction and having return of bowel function through his (Figure 2).
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