Small Bowel Obstruction in a Child on an Antipsychotic

Though decreased intestinal motility and constipation are well recognized anticholinergic side effects of antipsychotic medications, frank intestinal obstruction is an unusual complication. To our knowledge, this is the first report of a neuroleptic unmasking a previously unrecognized intestinal anomaly. A 7-year-old girl, with an asymptomatic congenital intestinal anomaly, developed an obstruction while on perphenazine and benztropine mesylate. Presenting with increasing abdominal pain within a few days of starting perphenazine, she required surgical correction of a jejunal ileus. Antipsychotics, and other medications with antiperistaltic activity, should be prescribed with caution, even in patients with asymptomatic gastrointestinal narrowing.