Presentation
Day 2 post operation (wide local excision, partial glossectomy, mandibulectomy & bilateral ND with free flap reconstruction and tracheostomy insertion secondary to FOM/anterior ventral tongue SCC) presenting with abdominal pain and distension.
Patient Data
The large bowel is distended throughout with the largest area of distension around the cecum at approximately 12.5 cm. NGT tip is seen and projected over the stomach.
This is a repeat abdominal x-ray 4 days post initial diagnosis of colonic pseudo-obstruction.
From the time of diagnosis to this point, the patient had received:
colonoscopy x3 to decompress the pseudo-obstruction.
IDC catheter insertion in the rectum to facilitate ongoing decompression
Neostigmine infusion and monitoring in the ICU stepped down to subcutaneous neostigmine on the ward
Some improvement in the distension of the large bowel can be appreciated, although still within the upper limits of normal.
Within a one-day gap, there was an incredible resolution from the distension still visible in the prior abdominal X-ray to this X-ray.
Case Discussion
Post-operative colonic pseudo-obstruction can also happen in post-operative patients without abdominal surgery. Thus, should be in the differential for post-op abdominal pain.
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