33-36 Andrea Cariati.indd

Ogilvie syndrome, or acute colonic pseudo-obstruction, is a severe distension of the colon caused by decreased large bowel motility in the absence of a mechanical obstruction. It can be a consequence of medical treatment such as with clozapine. An 82-year-old male with Alzheimer disease under treatment with antipsychotics (clozapine) was admitted with abdominal distension and constipation. On examination, the patient had distended abdomen and diffuse tenderness without rebound pain. He was afebrile. Laboratory blood tests were normal. Cardiac arrhythmia (frequent ventricular extrasystoles) was described. Abdominal X-ray showed a marked left bowel dilatation. The patient underwent intravenous saline therapy and nasogastric tube and anal tube placement. Furthermore, a colonoscopic decompression was performed, and stool and gas passed. The follow-up abdominal X-ray demonstrated the resolution of the obstruction. In patients affected by Ogilvie syndrome, after the failure of conservative management, the administration of intravenous neostigmine is indicated. Our case had frequent ventricular extrasystoles. Thus, in order to prevent the onset of fatal cardiac arrhythmias or heart block, a colonoscopic decompression was performed as second-line treatment. Surgical treatments are not preferred unless conservative or endoscopic managements fail.