Anticholinergics Stop the Pain and the Motions – A Lesson for Surgeons

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17-May-2821.pdf
Published Jun 1, 2022
DOI: https://doi.org/10.18103/mra.v10i5.2821

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Shaygan Nejadeh
University of Auckland Medical School, Auckland, New Zealand
Sophie Alpen
Taranaki Base Hospital, New Plymouth, New Zealand
Edmund Leung
Department of Surgery, University of Auckland, New Zealand

Abstract

Background: Small bowel obstruction commonly presents to surgeons acutely. Adhesions and hernias are the commonest causes. However, medical ileus and gastroparesis are often overlooked.


Case report: This article presents a case of an 82year-old woman on orthopaedic ward referred to the general surgeons with symptoms of small bowel obstruction: bilious vomiting and abdominal distension. Despite all conservative measures, symptoms did not improve. Oral contrast on cross-sectional imaging and gastrograffin follow-through consistently illustrated a transition point at the base of jejunum. No mass or mural lesion was seen. The patient was prescribed regular orphenadrine for cramps over her right periprosthetic femoral fracture. Surgical intervention was then considered on suspicion of adhesional small bowel obstruction. A day before the planned laparotomy, the general surgical team stopped orphenadrine as the last attempt to relieve her symptoms. Ceasing orphenadrine reversed her obstructive symptoms and signs within hours.


Conclusion: Orphenadrine has a broad range of anticholinergic effects that is known to cause gastroparesis and ileus, which is often overlooked. This article discusses the learning points of this case and reviews literature regarding its pharmacologic effects.

Keywords: Anticholinergics, bowel obstruction, ileus

Article Details

How to Cite
NEJADEH, Shaygan; ALPEN, Sophie; LEUNG, Edmund. Anticholinergics Stop the Pain and the Motions – A Lesson for Surgeons. Medical Research Archives, [S.l.], v. 10, n. 5, june 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2821>. Date accessed: 16 apr. 2024. doi: https://doi.org/10.18103/mra.v10i5.2821.
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Issue
Vol 10 No 5 (2022): Vol.10 Issue5, May,2022
Section
Research Articles

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