Ken-ichi Muramatsu¹, Hiroki Nagasawa¹, Ikuto Takeuchi¹, Youichi Yanagawa^1,

The patient was a 62-year-old woman who was found in an unconscious. She had paroxysmal atrial fibrillation, dyslipidemia and anxiety neurosis. On arrival, she was in a state of deep coma with hypotension and hypoxia. She underwent tracheal intubation and continuous infusion of noradrenalin. Her serum cholinesterase (butylcholinesterase) level was 2 IU/L. Organophosphate poisoning was suspected. On day three, she regained clear consciousness and accepted that she had intentionally ingested a bottle of fenitrothion with suicidal intent. On the 3rd day, her serum cholinesterase level decreased to 0 U/L, and remained at this level until the 7th day. Prolonged artificial ventilation was required due to weak respiration. On the 14th day, she presented shock, a deterioration of consciousness, a distended abdomen with the peritoneal stimulation sign. She was diagnosed with paralytic ileus with septic shock. Her general condition gradually improved with supportive therapy. At the end of treatment in our hospital, she barely could walk and feed for herself and was transferred to another hospital for rehabilitation. To our knowledge, this is the first reported case of delayed paralytic ileus after prolonged transient hypocholinesterasemia induced by fenitrothion poisoning, in which atropine was not used as treatment. Physicians should pay attention to the complication of paralytic ileus when a patient with organophosphate poisoning shows prolonged hypocholinesterasemia.

fenitrothion, ileus, delay, peritonitis