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Systematic review: acute colonic pseudo-obstruction.

M D Saunders1, M B Kimmey

  • 1Division of Gastroenterology, University of Washington, Seattle, 98195, USA.

Alimentary Pharmacology & Therapeutics
|November 5, 2005
PubMed
Summary
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Acute colonic pseudo-obstruction, a serious condition causing large bowel dilation without blockage, often affects hospitalized patients. Prompt recognition and treatment, like neostigmine or colonoscopy, are vital to reduce severe complications and mortality.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Internal Medicine

Background:

  • Acute colonic pseudo-obstruction (ACPO) is characterized by acute colonic dilation without mechanical obstruction.
  • ACPO is a significant cause of morbidity and mortality, particularly in hospitalized or institutionalized patients with severe underlying conditions.
  • The exact pathogenesis is unclear but involves autonomic dysregulation of colonic motor function, potentially triggered by metabolic, pharmacologic, or trauma-related factors.

Purpose of the Study:

  • To summarize the understanding of acute colonic pseudo-obstruction.
  • To highlight the importance of early recognition and management.
  • To review current treatment strategies for ACPO.

Main Methods:

  • Literature review of ACPO pathogenesis and management.

Related Experiment Videos

  • Analysis of treatment outcomes for neostigmine, colonoscopic decompression, and surgery.
  • Synthesis of data on morbidity and mortality associated with ACPO.

    • Main Results:

    • ACPO results from autonomic imbalance leading to colonic atony and dilation.
    • Intravenous neostigmine is the primary treatment, achieving decompression in most patients.
    • Colonoscopic decompression is the preferred intervention for neostigmine failures or contraindications.

    Conclusions:

    • Early diagnosis and management of ACPO are crucial for improving patient outcomes.
    • Neostigmine and colonoscopic decompression are effective non-surgical interventions.
    • Surgery is reserved for complicated cases involving perforation or peritonitis, which carry a high mortality risk.