SHM Converge Scientific Abstract ePoster Gallery-Atypical Treatment in Acute-on-Chronic Intestinal Pseudo-Obstruction

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This poster describes a rare pediatric case of acute-on-chronic colonic pseudo-obstruction, a condition that mimics bowel obstruction with abdominal pain, distension, and constipation but has no mechanical blockage. A 15-year-old girl with autism, selective mutism, scoliosis, marfanoid habitus, and intrauterine drug exposure presented with six months of worsening abdominal pain, constipation, and severe colonic distension. CT imaging showed marked dilation of the colon up to 10 cm without a transition point. Workup excluded Hirschsprung disease and neurologic causes.<br /><br />Initial management followed standard conservative measures, including NPO status, nasogastric decompression, IV fluids, rectal decompression, and decompressive colonoscopy, but these interventions did not resolve symptoms. A 1 mg dose of neostigmine was ineffective, while 1.5 mg produced significant temporary improvement in abdominal distension, though air later reaccumulated. Ultimately, anorectal botulinum toxin injections led to substantial improvement.<br /><br />The discussion highlights that chronic intestinal pseudo-obstruction in children is difficult to diagnose and manage, and treatment must balance avoiding overtreatment with not delaying care in severe cases. Neostigmine may improve colonic motility through cholinergic effects but carries risks such as bronchospasm and bradyarrhythmia, especially in children. Anorectal Botox is described as a generally safe option used in several pediatric anorectal and constipation-related disorders, with rare complications.<br /><br />Overall, the case emphasizes that pediatric colonic pseudo-obstruction can be refractory to standard therapy and may require alternative approaches such as neostigmine and Botox. Awareness of these options may improve outcomes in atypical or treatment-resistant pediatric patients.

Asset Subtitle

Brianna Skaff

Meta Tag

Author List Alexandra Pearce, Brianna Skaff, Giles Knowles, Jacob Gelman, Joseph Lynch, Lindsay Jones

Category Clinical Vignettes

Concept Pseudo-Obstruction

Concept Mechanical Bowel Obstruction

Concept Neostigmine

Concept Clinical Presentation

Concept Diagnostic Workup

Distinguished Non-Finalist

Presenter Organization WVU Medicine

Presenting Author Brianna Skaff

Track Pediatric

Keywords

pediatric colonic pseudo-obstruction

acute-on-chronic pseudo-obstruction

abdominal distension

constipation

neostigmine

anorectal botulinum toxin

decompressive colonoscopy

chronic intestinal pseudo-obstruction

Hirschsprung disease exclusion

pediatric gastrointestinal motility

Pseudo-Obstruction

Mechanical Bowel Obstruction

Neostigmine

Clinical Presentation

Diagnostic Workup