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Case report series of a novel application of neostigmine to successfully relieve refractory ileus status post-pediatric orthotopic liver transplantation.
Pediatr Transplant 2019; :e13564PT

Abstract

Post-operative ileus is common after abdominal surgeries. Children undergoing liver transplant are at increased risk of ileus for various reasons including multiple abdominal procedures and use of narcotic medications. Ileus can lead to abdominal compartment syndrome and compromise the integrity of the liver graft. In some of these patients, ileus is resistant to standard therapies including stool softeners, bowel stimulants, enemas, and even methylnaltrexone. Neostigmine has been shown in pediatric case series to be efficacious in some children for refractory post-operative ileus. We report three children (9 months, 3 years, and 12 years old) who developed refractory ileus after liver transplant, with one of them developing abdominal compartment syndrome, who were treated successfully with continuous infusions of neostigmine. Clinical responses included passage of flatus and stool and improvement in abdominal distension. All patients tolerated the infusion without serious adverse effects such as bradycardia or bronchospasm. Neostigmine was used safely in our patients and may be safe and efficacious for the treatment of refractory ileus in pediatric patients after liver transplantation. Neostigmine should be considered early in the treatment of these patients.

Authors+Show Affiliations

Section of Pediatric Critical Care Medicine, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.Section of Critical Care, Children's Hospital of Wisconsin, Milwaukee, Wisconsin. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin. Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31407849

Citation

Petersen, Pamela C., et al. "Case Report Series of a Novel Application of Neostigmine to Successfully Relieve Refractory Ileus Status Post-pediatric Orthotopic Liver Transplantation." Pediatric Transplantation, 2019, pp. e13564.
Petersen PC, Balakrishnan B, Vitola B, et al. Case report series of a novel application of neostigmine to successfully relieve refractory ileus status post-pediatric orthotopic liver transplantation. Pediatr Transplant. 2019.
Petersen, P. C., Balakrishnan, B., Vitola, B., & Hong, J. C. (2019). Case report series of a novel application of neostigmine to successfully relieve refractory ileus status post-pediatric orthotopic liver transplantation. Pediatric Transplantation, pp. e13564. doi:10.1111/petr.13564.
Petersen PC, et al. Case Report Series of a Novel Application of Neostigmine to Successfully Relieve Refractory Ileus Status Post-pediatric Orthotopic Liver Transplantation. Pediatr Transplant. 2019 Aug 13;e13564. PubMed PMID: 31407849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case report series of a novel application of neostigmine to successfully relieve refractory ileus status post-pediatric orthotopic liver transplantation. AU - Petersen,Pamela C, AU - Balakrishnan,Binod, AU - Vitola,Bernadette, AU - Hong,Johnny C, Y1 - 2019/08/13/ PY - 2019/01/27/received PY - 2019/06/03/revised PY - 2019/07/03/accepted PY - 2019/8/14/entrez KW - ileus KW - liver transplant KW - neostigmine KW - pediatric KW - postoperative SP - e13564 EP - e13564 JF - Pediatric transplantation JO - Pediatr Transplant N2 - Post-operative ileus is common after abdominal surgeries. Children undergoing liver transplant are at increased risk of ileus for various reasons including multiple abdominal procedures and use of narcotic medications. Ileus can lead to abdominal compartment syndrome and compromise the integrity of the liver graft. In some of these patients, ileus is resistant to standard therapies including stool softeners, bowel stimulants, enemas, and even methylnaltrexone. Neostigmine has been shown in pediatric case series to be efficacious in some children for refractory post-operative ileus. We report three children (9 months, 3 years, and 12 years old) who developed refractory ileus after liver transplant, with one of them developing abdominal compartment syndrome, who were treated successfully with continuous infusions of neostigmine. Clinical responses included passage of flatus and stool and improvement in abdominal distension. All patients tolerated the infusion without serious adverse effects such as bradycardia or bronchospasm. Neostigmine was used safely in our patients and may be safe and efficacious for the treatment of refractory ileus in pediatric patients after liver transplantation. Neostigmine should be considered early in the treatment of these patients. SN - 1399-3046 UR - https://www.unboundmedicine.com/medline/citation/31407849/Case_report_series_of_a_novel_application_of_neostigmine_to_successfully_relieve_refractory_ileus_status_post-pediatric_orthotopic_liver_transplantation L2 - https://doi.org/10.1111/petr.13564 DB - PRIME DP - Unbound Medicine ER -