A 78-year-old woman presents with acute massive colonic distension without mechanical obstruction on CT. The caecal diameter is 14 cm. The diagnosis is Ogilvie's syndrome (acute colonic pseudo-obstruction). After 48 hours of conservative management (NG tube, rectal tube, correcting electrolytes), she does not improve. The current evidence-based pharmacological treatment is:
- A Erythromycin IV (motilin agonist)
- B Metoclopramide IV (dopamine antagonist)
- C Neostigmine IV (anticholinesterase) — inhibits acetylcholinesterase, increasing colonic motility ✓
- D Octreotide SC (somatostatin analogue)
Explanation
Neostigmine (IV 2.5 mg over 3-5 minutes, with cardiac monitoring) is the evidence-based pharmacological treatment of choice for Ogilvie's syndrome unresponsive to conservative management. It inhibits acetylcholinesterase, thus increasing colonic parasympathetic (cholinergic) tone and promoting colonic peristalsis and evacuation. Clinical response rates of 80-90% are reported. Contraindications include bradycardia, bronchospasm, peptic ulcer, and mechanical obstruction. Colonoscopic decompression is the alternative for neostigmine failure. Erythromycin is used for gastroparesis (motilin agonist), not Ogilvie's syndrome.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.