<![CDATA[Postoperative ileus (POI) is common after abdominal surgery, and in patients with dementia, withdrawal of cholinesterase inhibitors combined with antipsychotics with anticholinergic effects may further impair gastrointestinal motility. This case report aims to analyse a patient with dementia and colon cancer who developed POI associated with cholinesterase inhibitor (ChEI) discontinuation and antipsychotic therapy, highlighting the clinical importance of monitoring drug interactions and their impact on postoperative intestinal motility. A 74-year-old male with a history of vascular dementia and grade 2 hypertension presented with abdominal distension, nausea, constipation for 3 days, and absence of flatus for the last 24 hours. Radiological imaging revealed colonic dilatation with coil spring appearance and multiple air-fluid levels, leading to a diagnosis of obstructive ileus, and an exploratory laparotomy was performed. Seven days after the surgery, the patient developed recurrent abdominal pain, nausea, vomiting, and impaired bowel movements with weakened peristalsis. A repeat laparotomy revealed persistent intestinal dysmotility unresponsive to fluid stimulation, necessitating the creation of a protective ileostomy. The combination of ChEIs and antipsychotics in dementia patients may increase the risk of POI. Close monitoring and careful therapeutic adjustments are essential in managing this vulnerable population.]]>
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