A patient presents with Ogilvie's syndrome (acute colonic pseudo-obstruction) after a major orthopedic surgery. The cecal diameter on CT is 11 cm. Initial conservative management fails after 48 hours. What is the next best step?
- A Emergency laparotomy and cecostomy
- B Colonoscopic decompression
- C IV neostigmine 2 mg infusion over 3-5 minutes with cardiac monitoring ✓
- D Surgical right hemicolectomy
Explanation
Neostigmine (2 mg IV over 3-5 minutes) is the first-line pharmacological treatment for Ogilvie's syndrome refractory to conservative measures, with a response rate of approximately 80-90%. It acts by inhibiting acetylcholinesterase, increasing colonic motility. Cardiac monitoring is mandatory as bradycardia can occur; atropine should be at bedside. If neostigmine fails or is contraindicated (e.g., mechanical obstruction, suspected ischemia), colonoscopic decompression is the next step. Surgery (cecostomy or colectomy) is reserved for perforation, ischemia, or failure of all pharmacological/endoscopic measures.
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.