Case Report of International Journal of Case Reports
Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report
Sherif Aly, MD 1,2; Gentian Kristo, MD, MPH, FACS1,3.
1Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA;
2Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA;
3Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
The etiology of post-operative ileus is usually multifactorial, but increased catecholamines have been implicated as an important cause. We present a case of catecholamine-induced prolonged post-operative ileus treated successfully with Pyridostigmine. A 70-year-old male underwent a low-anterior resection and diverting loop ileostomy for rectal cancer. Immediately post-operatively he developed refractory hypertensive urgency and a small bowel ileus. Biochemical testing revealed markedly elevated 24-hour urinary metanephrines and normetanephrines. However, radiologic studies failed to identify a pheochromocytoma. The ileus persisted despite employing a multimodal regimen consisting of avoidance of narcotic pain medications, gastric decompression via a nasogastric tube, maintenance of normal levels of electrolytes, parenteral nutritional support, and early mobilization. Two weeks after the surgery the patient was treated with oral Pyridostigmine with appropriate return of bowel function. Excessive circulating catecholamines play an important role in the etiology of refractory post-operative ileus, and cholinesterase inhibitors such as Pyridostigmine could be used as an effective treatment in such cases.
Disclosure Statement: The authors have no conflicts of interest or financial disclosures to declare.
Keywords: post-operative ileus; catecholamines; pheochromocytoma; cholinesterase inhibitor
How to cite this article:
Sherif Aly and Gentian Kristo. Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report. International Journal of Case Reports, 2019 4:77. DOI: 10.28933/ijcr-2019-04-2805
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