KMID : 0366220130480020145
|
|
Korean Journal of Hematology 2013 Volume.48 No. 2 p.145 ~ p.148
|
|
Acute colonic pseudo-obstruction following allogeneic stem cell transplantation successfully treated by neostigmine
|
|
Yahng Seung-Ah
Yoon Jae-Ho Shin Seung-Hwan Lee Sung-Eun Eom Ki-Seong Kim Yoo-Jin
|
|
Abstract
|
|
|
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie¡¯s syndrome, is a rare clinical syndrome of massive large bowel dilatation without mechanical obstruction, which may cause significant morbidity and mortality. Treatment focuses on decompressing a severely dilated colon. The proposed theory that this severe ileus results from an imbalance in the autonomous regulation of colonic movement supports the rationale for using neostigmine, a reversible acetylcholinesterase inhibitor, in patients who failed conservative care. Although gastrointestinal complications are frequent following allogeneic stem cell transplantation (SCT), the incidence of ACPO in a transplant setting is unknown and, if not vigilant, this adynamic ileus can be underestimated. We describe the case of a patient with myelodysplastic syndrome undergoing non-myeloablative allogeneic SCT from a partially human leukocyte antigen-mismatched sibling donor, and whose clinical course was complicated by ACPO in the early post-engraftment period. The ileus was not associated with gut graft-versus-host disease or infectious colitis. After 3 days of conservative care, intravenous neostigmine (2 mg/day) was administered for 3 consecutive days. Symptoms and radiologic findings began to improve 72 hours after the initial injection of neostigmine, and complete response without any associated complications was achieved within a week. Thus, neostigmine can be a safe medical therapy with successful outcome for patients who develop ACPO following allogeneic SCT.
|
|
KEYWORD
|
|
Acute colonic pseudo-obstruction, Ogilvie¡¯s syndrome, Myelodysplastic syndrome, Allogeneic stem cell transplantation
|
|
FullTexts / Linksout information
|
|
|
|
Listed journal information
|
|
|
|