Search Results (3)

Background: Acute colonic pseudo-obstruction (ACP) is a life-threatening, rare condition of non-mechanical colon dilatation that can result in bowel ischaemia and perforation. The aetiology is relatively unknown but includes older age coupled with high comorbidity, decreased parasympathetic activity, certain medications, chemoradiotherapy and recent surgery. There are limited research data on ACP following reversal of ileostomy after ultra-low anterior resections (ULAR), thus this systematic review included cases from various types of bowel surgeries. Methods: A comprehensive literature search of relevant articles was conducted using the EMBASE, Medline, PubMed, Cochrane, and Scopus databases. Two cases of ACP following ileostomy reversal after ULAR for rectal cancer were also reported from the authors’ rural institution. This systematic review was conducted according to PRISMA 2020 guidelines. Results: A total of 522 studies were screened of which five case reports were included. Two case series (six patients) and the two patients from the authors’ rural institution developed ACP following reversal of ileostomy post-ULAR with potential causes being the > 6 months’ time from initial surgery to reversal causing prolonged colonic mucosal inflammation and reduced wall contractile strength. Anastomotic leak and chemoradiotherapy were other considerations. One of the rural patients developed right colon ischaemia and perforation needing urgent laparotomy, right hemicolectomy and formation of end ileostomy and mucous fistula. Conservative treatment included aperients, enemas, flatus tube, bedside or endoscopic decompression, and neostigmine. Conclusions: Early recognition is vital to treat ACP with medical therapy and decompression to prevent bowel ischaemia and perforation. Further research is needed to better characterise the aetiology, incidence and management strategies for this rare condition. Full article

Background/Objectives: Individuals diagnosed with schizophrenia are susceptible to constipation induced by antipsychotic medications. However, research investigating the prevalence of this adverse effect and its underlying mechanisms is limited. Methods: To address this knowledge gap, a narrative review was conducted on the subject of constipation in patients with schizophrenia. A comprehensive electronic search was conducted in the PubMed and J-Stage databases. Results: The prevalence of constipation in individuals with schizophrenia is high, ranging from 30% to 60%. The risk of constipation increases with high doses of antipsychotics and with the concomitant use of anticholinergics and mood stabilizers. The prevalence of constipation varies by sex, with women demonstrating a higher risk compared to men. Conclusions: Constipation is a prevalent complaint among individuals with schizophrenia, with women exhibiting a higher risk. The underlying pathophysiology of sex differences in constipation is attributed to variations in monoamines within the descending pain inhibitory pathway, which governs the neural circuitry associated with defecation. Constipation can lead to significant complications, underscoring the need for a multifaceted approach to treatment that considers the intestinal environment beyond the mere use of laxatives. Full article

Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPS) is a rare occurrence, usually following surgery. It consists of a massive dilatation of the cecum, whose diameter becomes greater than 10 cm; its severity is variable, but, if not promptly recognized, it may be life-threatening. Acute kidney injury (AKI) is reported in this context due to both septic complications and to effective hypovolemia. ACPS most commonly affects males and individuals older than 60. In women, the median age at diagnosis is lower due to a strong association with Caesarean sections. The differential diagnosis after delivery may be challenging, due to a potential overlap of symptoms with preeclampsia or hemolysis low platelet elevated liver enzymes (HELLP) syndrome, both associated with AKI. The case herein discussed, regarding a 35-year-old woman, who developed AKI and Ogilvie syndrome after a Caesarean section for preeclampsia, may exemplify these diagnostic and therapeutic challenges, and is intended to raise awareness on this unusual complication of Caesarean delivery. Full article