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Neostigmine and glycopyrronium: a potential safe alternative for patients with pseudo-obstruction without access to conventional methods of decompression
  1. Alfred Adiamah1,
  2. Sarah Johnson2,
  3. Adrian Ho2,
  4. 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}


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.

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  • 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.

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