No abstract

A 50-year-old woman underwent total abdominal hysterectomy and bilateral salphingo-oophorectomy for heavy menstrual bleeding due to a uterine fibroid. On second post-operative day she developed progressive abdominal distention, tachycardia, and fever. An intra-abdominal pathology was suspected and she was re-opened on the third postoperative day. At laparotomy a distended colon was found with serosal tears due to distention with no distal colonic obstruction. Bowel decompression was done and a diagnosis of acute colonic pseudo-obstruction (ACPO) was made. Since her abdominal distention was persisting after the laparotomy she was treated with intravenous neostigmine. She responded immediately with passage of flatus and bowel opening. Subsequent recovery was uneventful. ACPO is a clinical entity characterized by severe colonic distention in the absence of mechanical obstruction. It can result in bowel ischaemia and perforation if left untreated. Therapeutic importance of neostigmine is discussed in the management of this potentially fatal condition.