Challenging differential diagnosis, Unexpected drug reaction , Educational Purpose (only if useful for a systematic review or synthesis), Rare co-existance of disease or pathology
Jose L. Pérez-Lara, Yaneidy Santana, Janette Hernández-Torres, Gilda Díaz-Fuentes
(Department of Internal Medicine, BronxCare Health System, Bronx, USA)
Am J Case Rep 2019; 20:278-284
Acute colonic pseudo-obstruction (ACPO) is an infrequent entity characterized by non-toxic, non-mechanical, abrupt, functional dilation of the colon. Clinically patients present with abdominal distention, anxiety, severe abdominal pain, nausea, and vomiting. This rare entity can lead to a fatal outcome if not recognized early. A high level of suspicions is paramount for early diagnosis and prompt intervention.
CASE REPORT: A 50-year-old male was admitted to the intensive unit care due to acute hypoxic respiratory failure, pneumonia, and septic shock requiring mechanical ventilation and intravenous vasopressors. Two weeks after admission, his clinical course deteriorated and was complicated with acute abdominal distension, pain, and ileus. Imaging confirmed acute onset of ileus and after ruling out metabolic and infectious causes, the diagnosis of ACPO was made. Aggressive medical and surgical management resulted in a favorable outcome.
CONCLUSIONS: Critically ill patients on ventilator are commonly sedated; therefore, usual symptoms of ACPO can be missed or misinterpreted leading to late diagnosis with increased morbidity and mortality. Clinicians must be aware of potential harm and side effects from common sedatives used in the intensive care unit and should be current on medical literature. Alpha-2 agonists, i.e., dexmedetomidine, is increasingly been used in critical care setting and there are few reports of a possible association with ACPO. We present here a case of a patient with dexmedetomidine-induced ACPO, and we provide a review of the existing literature and pathophysiology of the condition.
Keywords: Abdomen, Acute, Colectomy, Colonic Pseudo-Obstruction, Colonoscopy, dexmedetomidine, Decompression, Surgical, Adrenergic alpha-2 Receptor Agonists, Intestinal Pseudo-Obstruction, Ileus