Symptoms of abdomen acute surgical disease on 67 year old patient with myasthenia caused overdosing of pyridostygmine – clinical case
Keywords:
myasthenia gravis, acute abdomen, cholinergic crisisAbstract
The term peracute abdomen refers to a sudden, severe abdominal pain, vomiting, nausea and constipation. It may require an immediate surgical intervention. However in some cases manifestations suggesting the appearance of the surgical peracute disease are caused by another reasons and do not require to perform the treatment as a matter of urgency. It concerns patients with a clinical picture not fully relevant to the manifestations characteristic for this disease. In a described case of 67 year old woman admitted with the suspicion of the peracute abdomen and treated for three years with the high doses of pyridostigmine because of the myasthenia no operation treatment was implemented since the syndromes suggesting the surgical peracute disease of the abdominal cavity. This symptoms resulted from overdosing this medicine and cholinergic crisis. After conservative treatment (painkillers, relaxant, intravenous rolling fluids) a gradual remission was achieved. The patient gave correct stool back, increased tension of the stomach lining and pain disappeared and nausea with vomiting did not return. The discrepancies of the clinical picture including the increased peristalsis of intestines, pain of stomach clearly emphasized peritoneum syndromes, weakness and increased diaphoresis of skin were connected with coexistence of the myasthenia and application high doses of the pyridostygmine in the illness therapy.
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www.urpl.gov.pl/rejestr/Mestinon.pdf
-Year Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery N England J Med 358:2813, june 26, 2008 Case Records of the Massachusetts General Hospital.
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