BMJ Case Reports 2017; doi:10.1136/bcr-2017-221249
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Neostigmine and glycopyrronium: a potential safe alternative for patients with pseudo-obstruction without access to conventional methods of decompression

  1. James Orbell2
  1. 1Nottingham University Hospitals NHS Trust, Dorset County Hospital, Nottingham, UK
  2. 2Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
  1. Correspondence to Mr Alfred Adiamah, alfie.adiamah{at}
  • Accepted 27 August 2017
  • Published 11 September 2017


Intestinal pseudo-obstruction mimics bowel obstruction. However, on examination, no mechanical cause is identified. This condition will often resolve when managed conservatively, yet in some cases decompression is required to avoid the serious complications of bowel ischaemia and perforation. This is performed endoscopically, and due to the invasive nature and limited access to this service, an alternative treatment option is deemed appealing. Neostigmine has good efficacy in the decompression of pseudo-obstruction but is hindered by its wide side effect profile. In this context, neostigmine requires careful monitoring, which limits its appeal. This side effect profile is minimised when neostigmine is administered in conjunction with glycopyrronium.

This case demonstrates the novel use of neostigmine and glycopyrronium in decompression of the bowel in a patient with pseudo-obstruction. Furthermore, it highlights its value, particularly when conventional techniques for decompression are not accessible.


  • Contributors AA: writing, formatting and editing, content accuracy. SJ: drafting and editing. AH: drafting and editing. JO: supervision, layout, content accuracy, editing.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article