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1503 - A Case of Acute Colonic Pseudo-obstruction in Left Middle Cerebral Artery Stroke

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

HC

Hannah Campbell, BS

Osteopathic Medical Student
Lincoln Memorial University DeBusk College of Osteopathic Medicine
Macomb, Michigan, United States

Co-Author(s)

TW

Tiffany Wood, DO

PM&R Resident
University of Michigan PM&R
Ann Arbor, Michigan, United States
EC

Edward Claflin, MD

Associate Professor
Univ of Michigan Health
Ann Arbor, MI, Michigan, United States

Case Diagnosis: Acute Colonic Pseudo-obstruction in Left MCA Stroke

Case Description: A 43 year old female with no significant past medical history was admitted to an inpatient rehab facility (IPR) for Left MCA stroke. Her deficits included right-sided hemiplegia and verbal apraxia. Her last bowel movement at the outside hospital was several days prior to admission to IPR. A bowel regimen was started at the outside hospital and was continued at the time of admission to IPR. After two more days without a bowel movement, increased patient discomfort, and abdominal bloating, her bowel regimen was escalated. Ultimately, an abdominal radiograph was obtained revealing colonic dilatation secondary to acute colonic pseudo-obstruction. The patient received the standard of care management: she was made NPO, all bowel medications were halted, intravenous fluids were initiated, and she was closely monitored with serial abdominal radiographs and labs every twelve hours until resolution.

Discussions: Acute colonic pseudo-obstruction, or Ogilvie syndrome, is most commonly identified in males, and in patients older than 60. This complication presents in just 100 out of 100,000 patient admissions per year, and is most readily considered in post-surgical instances. Other common causes can include severe illness, long-term debility, electrolyte imbalances, or as a secondary effect of certain medications. However, in this case, this patient does not meet any of these demographics or aforementioned conditions, yet developed pseudo-obstruction.

Conclusions: The preceding, more common causes of colonic pseudo-obstruction are presumed causal agents because of their autonomic nervous system dysregulation. The ANS is also affected in stroke patients, though the relationship between stroke and pseudo-obstruction has been minimally investigated. In this patient’s case, ANS dysregulation secondary to stroke preceded the development of ileus and is worth consideration by physiatrists in the post-stroke population.