Recurrent thrombotic event in a young patient with MTFHR mutation and corona virus

Background and aims: Ogilvie's syndrome or Acute Colonic Pseudo-obstruction (ACP) is a rare condition that presents with colorectal distension in the absence of any mechanical obstruction. Unrecognized and untreated, it may lead to bowel perforation and ischemia. We report a case of ACP in a patient with Parkinson's disease (PD) and COVID-19 disease. Methods: A 78-year-old male with an eight-year history of PD, hypertension, diabetes and recent diagnosis of Covid19 (∼2 weeks prior), presented with a one-month history of abdominal pain, distension and constipation. His exam was significant for a distended and tympanitic abdomen without peritoneal signs. X-rays showed colonic distention with predominant aerocoly at the left colic angle without any identifiable organic obstacle. Labs revealed mild hypokalemia. Presentation was thought to be consistent with ACP. Initial treatment included stopping anti-PD drugs and electrolyte repletion. A trial of atropine failed to relieve the obstruction and resulted in transient bradycardia while colonoscopic decompression was successful and showed no underlying mucosal lesion. Results: ACP can be related to multiple etiologies such as diseases of centra l autonomic and enteric nervous systems (PD), or metabolic diseases (Diabetes Mellitus) and can be idiopathic in 5.5%of the cases. It is well established that electrolyte imbalances and certain medications including antiparkinsonians especially Levodopa, calcium blockers decrease gastrointestinal tract motility and may contribute to ACP. Conclusion: Our case highlights the importance of recognizing ACP in PD patients and fast initiation of symptomatic treatment in order to prevent catastrophic complications. The exact pathophysiology and cause of ACP remain unresolved. (Figure Presented).