EARLY RESOLUTION OF OGILVIES-SYNDROME WITH INTRAVENOUS NEOSTIGMINE - A SIMPLE, EFFECTIVE TREATMENT

PURPOSE: Our aim was to assess the value of a parasympathomimetic drug (neostigmine) in the early resolution of acute colonic pseudo-obstruc tion (Ogilvie's syndrome). METHODS: A prospective study was undertaken in 18 consecutive patients (mean age, 76 (range, 31-87) years) with a cute colonic pseudo-obstruction. After a varying period of conservativ e treatment in all cases, IG patients with persistent, massive abdomin al distention were given intravenous neostigmine. RESULTS: A rapid and satisfactory clinical and radiologic decompression of the large bowel was obtained in 12 patients (75 percent) after a single dose of the d rug; another patient had complete resolution after a second dose, and the other 3 patients had only partial resolution, in one of them after a second dose of the drug. No patient required surgical decompression of the bowel. CONCLUSION: These results give support to the theory of excessive parasympathetic suppression in most cases of Ogilvie's synd rome. The treatment with intravenous neostigmine has proved very effec tive, preventing in many cases prolonged periods of uncomfortable and potentially hazardous conventional conservative management and avoidin g surgical treatment in a consecutive series of patients.