Abstract / Summary
Background Acute colonic pseudo-obstruction (Ogilvie syndrome) is a rare but serious condition characterized by marked colonic dilatation without mechanical obstruction. Anticholinergic medications, including tricyclic antidepressants, have been implicated as potential causes.Case report We report a 64-year-old man who intentionally ingested approximately 2,500 mg of amitriptyline. Eleven hours later, he presented with depressed consciousness and anticholinergic manifestations. On hospital day 5, he developed progressive abdominal distension and obstipation. Computed tomography demonstrated marked bowel dilatation without a definite mechanical obstruction. Due to progressive bowel dilatation despite conservative management, exploratory laparotomy and decompressive cecostomy were performed. Postoperatively, the patient developed septic shock and multiorgan dysfunction requiring vasopressor support and continuous renal replacement therapy. He subsequently recovered and was discharged in stable condition.Discussion Amitriptyline overdose may cause severe gastrointestinal hypomotility resulting in acute colonic pseudo-obstruction. Clinicians should recognize this uncommon complication when evaluating patients with abdominal distension after tricyclic antidepressant poisoning.