Refractory Acute Colonic Pseudo-Obstruction Complicated by Urosepsis and Parkinsonism

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, consists of massive colonic dilatation in the absence of distal colonic mechanical obstruction. It develops in hospitalized patients and is associated with a variety of surgical and medical conditions, such as autonomic dysregulation of colonic motor activity, after major surgery, electrolyte imbalance, or systemic infection. Conservative management or pharmacological therapy with neostigmine is usually sufficient to control ACPO, but colonoscopy for intestinal decompression is sometimes needed. We report a patient with Parkinson's disease who developed ACPO after septic shock. Low dose of neostigmine (1 mg) is effective for short-term symptom relief; but the symptoms might be recurrent and refractory if the underlying risk factors are not improved. Without appropriate management, ACPO will prolong the duration of mechanical ventilation and ICU stay of those critical patients.