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Acute colonic pseudoobstruction.

Michael D Saunders1

  • 1Division of Gastroenterology, University of Washington Medical Center, 1959 NE Pacific Avenue, Box 356424, Seattle, WA 98195, USA. mds@u.washington.edu

Current Gastroenterology Reports
|September 3, 2004
PubMed
Summary
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Acute colonic pseudoobstruction (ACPO) is a large bowel obstruction without mechanical blockage, often seen in hospitalized patients. Intravenous neostigmine is the primary treatment, with colonoscopic decompression as a secondary option.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Internal Medicine

Background:

  • Acute colonic pseudoobstruction (ACPO) presents as large bowel obstruction without mechanical blockage.
  • It predominantly affects hospitalized patients with severe medical or surgical conditions, contributing significantly to morbidity and mortality.
  • The exact cause is unknown but linked to autonomic nervous system dysregulation of colonic motility.

Purpose of the Study:

  • To summarize the understanding of ACPO, including its pathogenesis, clinical significance, and management strategies.
  • To highlight the importance of early recognition and intervention to reduce mortality.
  • To review current treatment options for ACPO.

Main Methods:

  • Literature review of ACPO, focusing on pathogenesis, clinical presentation, and treatment outcomes.

Related Experiment Videos

  • Analysis of existing data on the efficacy of neostigmine and colonoscopic decompression.
  • Evaluation of surgical indications for ACPO management.

    • Main Results:

    • ACPO pathogenesis involves autonomic imbalance, potentially due to metabolic, pharmacologic, or trauma-related factors, leading to colonic atony.
    • Intravenous neostigmine is highly effective, achieving prompt decompression in most patients.
    • Colonoscopic decompression is the preferred alternative for non-responders or those with contraindications to neostigmine.

    Conclusions:

    • Early diagnosis and management of ACPO are crucial for improving patient outcomes and reducing mortality.
    • Neostigmine is the first-line treatment, offering rapid relief.
    • Surgery is reserved for complicated cases involving perforation or peritonitis.