A Case of Acute Colonic Pseudo-Obstruction Combined with Rhabdomyolysis induced by Severe Hypokalemia

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.

중증 저칼륨혈증에 의해 발생한 횡문근 융해증이 합병된 급성 대장 가성 폐쇄증 1예

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.