Guanghao Liu1, Jennifer Hrabe2, Rolando Sanchez3. 1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, 52333, USA. Guanghao-liu@uiowa.edu. 2. Department of Surgery, Division of Gastrointestinal, Minimally invasive and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, 52333, USA. 3. Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, 52333, USA.
Abstract
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease, and ALS patients may experience disturbed gastrointestinal motility often resulting in acute colonic pseudo-obstruction (ACPO). There is currently a paucity in the literature to guide the treatment of patients with both ALS and ACPO. CASE PRESENTATION: Here we describe a 39-year-old male patient with advanced ALS who developed ACPO. His condition was refractory to both medical and procedural managements including polyethylene glycol, senna, and docusate suppository, metoclopramide, linaclotide, erythromycin, prucalopride, neostigmine, and repeated colonoscopies. He ultimately underwent successful colostomy for palliation. Here we report the peri-operative multidisciplinary approach taken with this case, the surgical procedures, the potential risks, and the outcome. CONCLUSION: The patient is delighted with the result and requested publication of this case to raise awareness of constipation in ALS patients and promote the consideration of colostomy as a treatment option for patients with ileus resistant to conservative management. Ultimately, a multidisciplinary team approach is required to properly assess the risks and benefits to achieve good clinical outcomes.
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease, and ALS patients may experience disturbed gastrointestinal motility often resulting in acute colonic pseudo-obstruction (ACPO). There is currently a paucity in the literature to guide the treatment of patients with both ALS and ACPO. CASE PRESENTATION: Here we describe a 39-year-old male patient with advanced ALS who developed ACPO. His condition was refractory to both medical and procedural managements including polyethylene glycol, senna, and docusate suppository, metoclopramide, linaclotide, erythromycin, prucalopride, neostigmine, and repeated colonoscopies. He ultimately underwent successful colostomy for palliation. Here we report the peri-operative multidisciplinary approach taken with this case, the surgical procedures, the potential risks, and the outcome. CONCLUSION: The patient is delighted with the result and requested publication of this case to raise awareness of constipation in ALS patients and promote the consideration of colostomy as a treatment option for patients with ileus resistant to conservative management. Ultimately, a multidisciplinary team approach is required to properly assess the risks and benefits to achieve good clinical outcomes.
Authors: M Toepfer; M Schroeder; A Klauser; H Lochmüller; M Hirschmann; R L Riepl; D Pongratz; W Müller-Felber Journal: Eur J Med Res Date: 1997-11-28 Impact factor: 2.175
Authors: A Chiò; G Logroscino; B J Traynor; J Collins; J C Simeone; L A Goldstein; L A White Journal: Neuroepidemiology Date: 2013-07-11 Impact factor: 3.282
Authors: M Toepfer; C Folwaczny; A Klauser; R L Riepl; W Müller-Felber; D Pongratz Journal: Amyotroph Lateral Scler Other Motor Neuron Disord Date: 1999-12