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A 54-year-old male was admitted because of abdominal pain and distension. Four days prior to admission, he visited the emergency room for flank pain, and was diagnosed as having a ureteral stone. With conservative therapy, including anticholinergics and diazepam, pain was relieved and the patient was discharged. After discharge, diffuse abdominal pain developed, and he could not defecate for three days. On the day of admission, he underwent extracoporeal shock wave lithotripsy for the stone. Consequently, his symptoms became more aggravated. Abdominal radiography revealed massive colonic dilatation. Neither a sigmoidoscopy nor a CT scan revealed any evidence of an obstructive lesion. Despite conservative care, colonic distension progressed. After insertion of a colonic manometry catheter, he received 2.0 mg of neostigmine. After several minutes, a massive amount of gas and stool evacuated, and abdominal distension was relieved. The history and clinical course suggest that the development and aggravation of acute colonic pseudo-obstruction is associated with a ureteral stone, drugs and extracorporeal shock wave lithotripsy.