Ann Rehabil Med.  2012 Apr;36(2):278-281. 10.5535/arm.2012.36.2.278.

Occurrence of Intestinal Pseudo-obstruction in a Brainstem Hemorrhage Patient

• Lee SJ
• Na IH
• Choi ES
• Jung SH
• Yoon JS

• KMID: 2266769
• DOI: http://doi.org/10.5535/arm.2012.36.2.278

Abstract

Intestinal pseudo-obstruction is a massive colonic dilation with signs and symptoms of colonic obstruction, but without a mechanical cause. A 49-year-old female patient complained of nausea, vomiting, and abdominal distension 1 month after a massive brainstem hemorrhage. No improvement was seen with conservative treatments. An extended-length rectal tube was inserted to perform glycerin enema. In addition, bethanechol (35 mg per day) was administered to stimulate colonic motility. The patient's condition gradually improved over a 2-month period without any surgical intervention. Extended length rectal tube enema and bethanechol can be used to improve intestinal pseudo-obstruction in stroke patients.

Keyword

Intestinal pseudo-obstruction; Rectal tube; Bethanechol

MeSH Terms

Bethanechol
Brain Stem
Colon
Enema
Female
Glycerol
Hemorrhage
Humans
Intestinal Pseudo-Obstruction
Middle Aged
Nausea
Stroke
Vomiting
Bethanechol
Glycerol

Figure

• 

  Fig. 1 Brain MRI of the patient (2 months after onset) shows massive brainstem hemorrhage involving area from midbrain, pons to cerebellum in axial T2 weighted FLAIR image.

• 

  Fig. 2 Plain radiograph of a patient shows fecal impaction and marked gaseous dilatation in large and small bowel. Maximum diameter in ascending colon was 95 mm.

• 

  Fig. 3 Extended length rectal tube was inserted up to sigmoid colon with improvement of pseudo-obstruction.

Reference

1. Antonucci A, Fronzoni L, Cogliandro L, Cogliandro RF, Caputo C, De Giorgio R, Pallotti F, Barbara G, Corinaldesi R, Stanghellini V. Chronic intestinal pseudo-obstruction. World J Gastroenterol. 2008; 14:2953–2961. PMID: 18494042.

2. Su Y, Zhang X, Zeng J, Pei Z, Cheung RT, Zhou QP, Ling L, Yu J, Tan J, Zhang Z. New-onset constipation at acute stage after first stroke: incidence, risk factors, and impact on the stroke outcome. Stroke. 2009; 40:1304–1309. PMID: 19228840.

3. Saunders MD. Acute colonic pseudo-obstruction. Gastrointest Endosc Clin N Am. 2007; 17:341–360. PMID: 17556152.

4. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986; 29:203–210. PMID: 3753674.

5. Wood JD, Alpers DH, Andrews PL. Fundamentals of neurogastroenterology. Gut. 1999; 45(Suppl 2):II6–II16. PMID: 10457039.

6. Ito T, Sakakibara R, Sakakibara Y, Mori M, Hattori T. Medulla and gut. Intern Med. 2004; 43:1091. PMID: 15609712.

7. Fazel A, Verne GN. New solutions to an old problem: acute colonic pseudo-obstruction. J Clin Gastroenterol. 2005; 39:17–20. PMID: 15599204.

8. De Giorgio R, Barbara G, Stanghellini V, Tonini M, Vasina V, Cola B, Corinaldesi R, Biagi G, De Ponti F. Review article: the pharmacological treatment of acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2001; 15:1717–1727. PMID: 11683685.

9. Law NM, Bharucha AE, Undale AS, Zinsmeister AR. Cholinergic stimulation enhances colonic motor activity, transit, and sensation in humans. Am J Physiol Gastrointest Liver Physiol. 2001; 281:G1228–G1237. PMID: 11668032.

10. Durai R, Ng PC. 'Flatus tube enema' as an alternative to flexible sigmoidoscopy in reducing colonic volvulus and pseudo-obstruction: letter. Int J Colorectal Dis. 2009; 24:725–726. PMID: 19165489.