Abstract
Acute colonic pseudo-obstruction (ACPO) or Ogilvie's syndrome is a rare disorder of intestinal motility characterized by massive colonic dilatation without mechanical obstruction. We report a case of ACPO combined with rhabdomyolysis induced by severe hypokalemia. A 78-year-old male with a 10-year history of hypertension presented with abdominal pain and distension for 2 days. The laboratory findings showed hypokalemia with markedly elevated serum creatine phosphokinase and myoglobin levels. A plain abdominal x-ray revealed a markedly distended ascending and transverse colon with a cut-off sign at the descending colon. Mechanical obstruction of the intestine was excluded by computed tomography and colonoscopy. He was initially treated with supportive therapy, including insertion of a rectal tube and intravenous fluids with potassium replacement. However, the ACPO persisted, and neostigmine was administered in two separate 2.0-mg intravenous injections, 24 hours apart. Subsequently, the abdominal pain and colonic distension were relieved.
급성 대장 가성 폐쇄증은 자율 신경 이상과 관련된 다양한 원인에 의해 발생할 수 있으며, 드물게 저칼륨혈증에 의해서도 유발된다. 저자 등은 복부 팽만과 복통을 주소로 내원한 환자에서 혈청 검사, 심전도, 방사선 및 내시경 소견 등을 근거로 중증 저칼륨혈증에 의한 횡문근 융해증과 급성 대장 가성 폐쇄증을 진단하였으며, 이후 대증요법 시행과 네오스티그민 투여 후 임상 소견이 호전된 증례를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다.