Pyo Jeung Hui, Min Yang Won, Rhee Poong-Lyul
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2016 Feb;67(2):103-6. doi: 10.4166/kjg.2016.67.2.103.
Neostigmine can successfully decompress patients with acute colonic pseudo-obstruction (ACPO) who are unresponsive to conservative therapy. However, neostigmine is contraindicated in renal failure, so it is underused in ACPO patients with renal failure who would be otherwise appropriate candidates. We described the first successfully treated case of acute kidney injury (AKI) with neostigmine in a patient with ACPO. A 72-year-old man who underwent a coronary artery bypass graft surgery 11 days prior presented to the emergency room with abdominal distension, peripheral edema, and dyspnea on exertion. Plain abdominal radiographs and abdomen computed tomography scan showed diffuse colonic dilatation without obstruction. Serum creatinine level was increased five-fold over baseline. We diagnosed the patient as ACPO with AKI. With conservative treatment, renal function failed to improve because the ACPO was not corrected. Administration of neostigmine rapidly resolved ACPO and renal function, avoiding more invasive procedures such as colonoscopic decompression and hemodialysis. Neostigmine appears to be an effective and safe treatment option for ACPO patients with renal failure. Prospective large-scale studies should be carried out to determine the safety and efficacy of neostigmine in ACPO patients with renal failure.
新斯的明能够成功地为对保守治疗无反应的急性结肠假性梗阻（ACPO）患者解除梗阻。然而，新斯的明在肾衰竭患者中属禁忌，因此在本可作为合适治疗对象的肾衰竭ACPO患者中未得到充分应用。我们报道了首例使用新斯的明成功治疗的ACPO合并急性肾损伤（AKI）患者。一名72岁男性，在11天前接受了冠状动脉搭桥手术，因腹胀、外周水肿和劳力性呼吸困难就诊于急诊室。腹部平片和腹部计算机断层扫描显示结肠弥漫性扩张但无梗阻。血清肌酐水平较基线升高了五倍。我们诊断该患者为ACPO合并AKI。采用保守治疗后，由于ACPO未得到纠正，肾功能未能改善。使用新斯的明后迅速缓解了ACPO并改善了肾功能，避免了更具侵入性的操作，如结肠镜减压和血液透析。新斯的明似乎是肾衰竭ACPO患者有效且安全的治疗选择。应开展前瞻性大规模研究以确定新斯的明在肾衰竭ACPO患者中的安全性和有效性。
