POSTOPERATIVE ILEUS, PREGNANCY-RELATED CHOLINESTERASE DEFICIENCY AND SUXAMETHONIUM AFTER-PAINS

An account is presented of a patient who developed ileus, of greater or lesser severity, after each of seven operations (including two extra-abdominal and three Caesarean sections). During her most recent pregnancy, reviewed here, her plasma cholinesterase activity was found to be decreased and it remained low until at least the 6th day post-partum. However, as the normal activity had been gained by 6 weeks after delivery, the phenomenon had evidently been pregnancy-related. Despite receiving suxamethonium by infusion to completion of her Caesarean section, she did not show an abnormally prolonged response, although she did suffer considerable suxamethonium "after-pains". The question is posed of a possible relationship between the postoperative ileus, muscle pains and the decrease in cholinesterase activity. This report is presented because of the unusual galaxy of features, the relationship of which, one to another, is conjectural. CASE REPORT The patient (age 41 yr, weight 47.5 kg) was 15 weeks pregnant when first seen at the Ante-natal Clinic. Argentinian by birth, the patient was medically qualified, sensible, articulate and surprisingly phlegmatic. She had undergone four operations in Argentina (torsion of an ovarian cyst; an operation for her severe kyphoscoliosis; cholecystectomy; re-moval of adenomata from both breasts), and two in Scotland (Caesarean section). After each of these operations, whether intra- or extra-abdominal, she had suffered severely from postoperative ileus, the treatment in each instance being, apparently, naso-gastric suction plus the infusion of fluid i.v. These episodes of ileus lasted for 2-3 days and were characterized, by the patient, as being very distressing, owing to the pain of abdominal dis-tension. There was a suggestion that she had had some difficulty in breathing after at least one of the operations. Her general condition was good except for marked kyphoscoliosis. As a speculative procedure, blood was sampled for the measurement of cholines-