Severe Colonic Dysmotility and Constipation Leading to Hydronephrosis in Advanced Parkinson's Disease: A Case Report and Literature Review.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms and significant non-motor complications, including gastrointestinal disturbances. Constipation, which affects up to 80% of PD patients, is one of the most common and debilitating gastrointestinal symptoms. This case report describes a 77-year-old female with advanced PD, who presented multiple times to the emergency department with recurring symptoms of vomiting, abdominal pain, and severe abdominal distension. Imaging studies revealed rectosigmoid colonic dilation, fecal impaction, and right hydronephrosis and hydroureter, caused by external compression from the distended colon - a rare complication in PD. The condition was clinically diagnosed as colonic dysmotility, linked to alpha-synuclein deposition in the enteric nervous system. Management included a unique combination of rectal tube placement, manual disimpaction, and pharmacological therapy, which successfully alleviated her symptoms and resolved the associated complications. Despite the effective management of symptoms, no current therapies exist to prevent or address the underlying alpha-synuclein-related colonic dysmotility. This case underscores the need for early recognition of severe colonic dysmotility in PD and highlights the importance of further research into targeted treatments that address the complex pathophysiology of gastrointestinal dysfunction in PD.