Acute colonic pseudo-obstruction in a child taking trihexyphenidyl for drooling: Prescribers beware

Area of Science:

• Pediatric Gastroenterology
• Clinical Case Reports
• Pharmacology

Background:

• Colonic pseudo-obstruction (Ogilvie's Syndrome) is rare in pediatric populations.
• Anticholinergic medications, like trihexyphenidyl, are used for conditions such as drooling.
• Patients with pre-existing intestinal hypomotility are at higher risk for gastrointestinal complications.

Observation:

• An 8-year-old child with cerebral palsy and chronic hypomotility was treated with trihexyphenidyl for drooling.
• The child presented with acute abdominal distension, tenderness, and vomiting, indicative of an obstruction.
• Emergency laparotomy revealed significant colonic dilatation.

Findings:

• This case represents the first reported instance of colonic pseudo-obstruction potentially linked to trihexyphenidyl use.
• The anticholinergic effects of trihexyphenidyl may exacerbate underlying intestinal hypomotility, leading to pseudo-obstruction.
• Surgical intervention, including a defunctioning ileostomy, was necessary to manage the acute condition.

Implications:

• Healthcare providers should exercise caution when prescribing trihexyphenidyl to pediatric patients with pre-existing intestinal hypomotility.
• Awareness of this potential adverse drug reaction is crucial for early diagnosis and management of colonic pseudo-obstruction.
• Further research may be warranted to explore the specific mechanisms and incidence of trihexyphenidyl-induced colonic pseudo-obstruction in vulnerable pediatric populations.