Treatment of acute colonic pseudo-obstruction with neostigmine

Background: Colonic pseudo-obstruction is a poorly understood syndrome, des cribed by Ogilvie,(1) 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 r esults with pharmacologic manipulation with neostigmine have been described . Study Design: A prospective study was undertaken with 11 consecutive patien ts with clinical and radiologic signs of colonic pseudo-obstruction, in one general hospital, over a 1-year period. Patients were treated primarily wi th 2.5 mg of neostigmine in 100 mL of saline for 1 hour, under cardiac moni toring. Results were assessed by the clinical and radiologic responses. Results: Rapid and effective spontaneous decompression of the colon was ach ieved in 8 patients after a single dose of neostigmine, within a mean of 90 minutes from the beginning of treatment. In another two patients decompres sion occurred only after a second dose was administered 3 hours after the f irst dose. In one patient, no changes were observed and colonoscopic decomp ression was performed. No significant bradycardia was observed in any of th e patients. Conclusions: Neostigmine is a simple, safe, and effective therapy for treat ment of colonic pseudo-obstruction. (J Am Coll Surg 2000;190:315-318. (C) 2 000 by the American College of Surgeons).