Effective and Safe Use of Neostigmine in Treatment of Acute Kidney Injury Associated with Colonic Pseudo-obstruction after Cardiac Surgery

Neostigmine can successfully decompress patients with acute colonic pseudo-obstruction (ACPO) who are unresponsive to conservative therapy. However, neostigmine is contraindicated in renal failure, so it is underused in ACPO patients with renal failure who would be otherwise appropriate candidates. We described the first successfully treated case of acute kidney injury (AKI) with neostigmine in a patient with ACPO. A 72-year-old man who underwent a coronary artery bypass graft surgery 11 days prior presented to the emergency room with abdominal distension, peripheral edema, and dyspnea on exertion. Plain abdominal radiographs and abdomen computed tomography scan showed diffuse colonic dilatation without obstruction. Serum creatinine level was increased five-fold over baseline. We diagnosed the patient as ACPO with AKI. With conservative treatment, renal function failed to improve because the ACPO was not corrected. Administration of neostigmine rapidly resolved ACPO and renal function, avoiding more invasive procedures such as colonoscopic decompression and hemodialysis. Neostigmine appears to be an effective and safe treatment option for ACPO patients with renal failure. Prospective large-scale studies should be carried out to determine the safety and efficacy of neostigmine in ACPO patients with renal failure.