A 50-year-old male presented to the ER with history of road side accident. He was operated under spinal anesthesia. Post-op 1 day after the operation, the patient repoed labored breathing, nausea and vomiting. Patient had last passed stool 3 days ago. On examination, Distended abdomen Tympanic note Scattered bowel sounds Water soluble enema failed to relieve the symptoms. X ray abdomen and CT were ordered. Which of the following drugs have been approved to be given in the above condition: -

This is a case of colonic pseudo-obstruction/ Ogilvie syndrome. Radiological images show colonic dilation involving the right and transverse colon with no evidence of mechanical obstructive cause. Defined as an acute pseudo-obstruction and dilatation of the colon in the absence of any mechanical obstruction. Patients usually present with constipation, nausea, vomiting and abdominal distension. Pseudo-obstruction can present with a sudden painless enlargement of the proximal colon accompanied by distension. Bowel sounds are normal or high-pitched, but should not be absent. The hallmark is the presence of dilatation of the large bowel (often marked) without evidence of an abrupt transition point or mechanically obstructing lesion. Medical treatment options include anticholinesterases like neostigmine and antibiotics like erythromycin. Decompression with a rectal tube (endoscopic decompression) or careful colonoscopy may be effective