Twenty-one patients with acute abdominal distention and radiographic evidence of colonic pseudo-obstruction with a caecal diameter of at least 10 cm were randomised to receive either 2 mg of neostigmine intravenously or intravenous saline 1. Ten of the 11 patients who received neostigmine, but none of 10 who received placebo, had prompt colonic decompression (the median time to response was 4 minutes) (p<0.001). Seven patients in the placebo group and the one patient in the neostigmine group without an initial response received open-label neostigmine; all had colonic decompression. Side effects of neostigmine inculuded abdominal pain, excess salivation, and vomiting. Symptomatic bradycardia developed in two patients and was treated with atropine.
Comment: The quality of evidence is downgraded by imprecise results (limited study size).
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