Acute Intestinal Obstruction in a Case of Cerebrovascular Accident

TL;DR

A middle-aged man developed intestinal pseudo-obstruction after a stroke and was successfully treated with IV neostigmine.

Contribution

This case highlights the successful use of IV neostigmine in treating intestinal pseudo-obstruction following a cerebrovascular accident.

Findings

IV neostigmine effectively relieved symptoms of intestinal pseudo-obstruction in a post-stroke patient.

Conservative treatment failed initially but was followed by successful pharmacological intervention.

The case supports the use of neostigmine in preventing intestinal complications in non-mechanical obstructions.

Abstract

Ogilvie's syndrome represents an acute form of intestinal obstruction that occurs in the absence of a detectable mechanical blockage impeding fecal passage. Hence, it is also given the name of intestinal pseudo-obstruction. It has been deemed a disease of imbalance between the arms of the autonomic nervous system with an increase in parasympathetic outflow. Most often, it has an antecedent surgical or medical illness. There is evidence for the use of IV neostigmine in such cases to prevent imminent intestinal ischemia and perforation. In the case of a non-responder, decompression of the bowel using a colonoscope and surgery have also been tried to relieve the symptoms. In the case that follows, a middle-aged man developed progressive abdominal distension in the course of his recovery from an ischemic cerebrovascular accident. Initially, he received conservative treatment for 48 hours. Subsequently, he was given IV neostigmine, which relieved his symptoms.

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