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Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a term for massive dilation of the colon without mechanical obstruction. This condition tends to occur in hospitalized patients and occasionally results in perforation and death. Building upon promising results of uncontrolled studies, researchers from the University of Washington randomized 21 patients with acute colonic pseudo-obstruction to receive either a 2-mg intravenous dose of neostigmine (an acetylcholinesterase inhibitor) or placebo. Cecal diameter ranged from 10 to 24 cm, and no patients had improved after 24 hours of conservative management.
Prompt colonic decompression occurred in 10 of 11 patients in the neostigmine group and none of 10 in the placebo group, a highly sign…