Refractory Acute Colonic Pseudo-Obstruction Complicated by Urosepsis and Parkinsonism

急性大腸假性阻塞，或稱爲奧格維氏症候群(Ogilvie's syndrome)，在臨床的表現上常易與腸道機械性阻塞混淆，但經過詳細的影像學甚至是大腸鏡的檢查，可確認無機械性阻塞的病兆存在。急性大腸假性阻塞好發於重症病人，主要肇因於支配控制腸道蠕動的自主神經失調，然而包括抗腸道蠕動藥物、重大手術術後、嚴重的內科疾病、電解質或代謝產物的不平衡及敗血症等，均可能加重假性阻塞的嚴重度。若大腸擴張程度尚不嚴重，保守性的支持療法或給予新斯狄格明(neostigmine)，常有不錯的療效。我們報告一位患有帕金森氏症的病患，因泌尿道感染引發敗血性休克住進加護病房，感染控制後出現腹脹，糞便減少及腸道擴張的現象，經過影像學診斷排除機械性阻塞之可能，診斷爲急性大腸假性阻塞。經過保守性治療包括積極感染控制、電解質補充及總共九次的新斯狄格明(neostigmine)治療，經過四個星期才逐漸改善假性阻塞症狀並順利脫離呼吸器拔管。

關鍵字

急性大腸假性阻塞；奧格維氏症候群Ogilvie's syndrome ；新斯狄格明neostigmine

並列摘要

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, consists of massive colonic dilatation in the absence of distal colonic mechanical obstruction. It develops in hospitalized patients and is associated with a variety of surgical and medical conditions, such as autonomic dysregulation of colonic motor activity, after major surgery, electrolyte imbalance, or systemic infection. Conservative management or pharmacological therapy with neostigmine is usually sufficient to control ACPO, but colonoscopy for intestinal decompression is sometimes needed. We report a patient with Parkinson's disease who developed ACPO after septic shock. Low dose of neostigmine (1 mg) is effective for short-term symptom relief; but the symptoms might be recurrent and refractory if the underlying risk factors are not improved. Without appropriate management, ACPO will prolong the duration of mechanical ventilation and ICU stay of those critical patients.

並列關鍵字

Acute colonic pseudo-obstruction ； Ogilvie's syndrome ； Neostigmine

國際替代計量

Refractory Acute Colonic Pseudo-Obstruction Complicated by Urosepsis and Parkinsonism

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