Quetiapine-induced paralytic ileus in a male patient in his 40s with polypharmacy

Objective: To report a case of constipation and ileus in a man with severe intellectual disability, symptomatic epilepsy, and other diseases, receiving quetiapine, and highlight that drug-induced constipation and/or paralytic ileus should be considered in patients treated with quetiapine. Patient and Methods: A man in his 40s was admitted presenting with protracted vomiting and poor oxygenation. His abdomen was distended, with a gastrostomy tube in place. The patient was taking multiple medications. Approximately 10 days after admission, a liquid diet was administered through the gastrostomy tube but was discontinued after the patient developed vomiting due to paralytic ileus and constipation. Computed tomography revealed abundant intestinal gas and no faecal mass in the colorectum. After the gradual substitution of quetiapine with risperidone, his symptoms improved. Results: Quetiapine-associated paralytic ileus was diagnosed. After 2 months of hospitalization, the patient was safely discharged from our hospital and moved to the previous facility. Conclusion: In patients using quetiapine and presenting with constipation and paralytic ileus, quetiapine-associated constipation and paralytic ileus should be considered. The substitution of quetiapine with other drugs and the gradual increase in a liquid diet may be effective in improving bowel movements.