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Acute colonic pseudo-obstruction.

Michael D Saunders1

  • 1Division of Gastroenterology, University of Washington Medical Center, 1959 Northeast Pacific Avenue, Suite AA103P, Box 356424, Seattle, WA 98195, USA. michaels@medicine.washington.edu

Gastrointestinal Endoscopy Clinics of North America
|June 9, 2007
PubMed
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Acute colonic pseudo-obstruction (ACPO) causes massive colon dilation without blockage in hospitalized patients. Early recognition and management, including supportive therapy and decompression, are critical to minimize severe complications and mortality.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Internal Medicine

Background:

  • Acute colonic pseudo-obstruction (ACPO) is a severe condition characterized by significant colon dilation without mechanical blockage.
  • It commonly affects hospitalized patients with critical underlying medical or surgical conditions.
  • Mortality rates are high, particularly when complications like ischemia or perforation are present.

Purpose of the Study:

  • To outline the diagnostic and management strategies for acute colonic pseudo-obstruction.
  • To identify key factors influencing patient outcomes and mortality in ACPO.
  • To emphasize the importance of early detection and intervention.

Main Methods:

  • Clinical evaluation to exclude mechanical obstruction and other causes of toxic megacolon (e.g., Clostridium difficile infection).

Related Experiment Videos

  • Assessment for signs of colonic ischemia and perforation.
  • Risk stratification based on factors such as age, cecal diameter, and duration of distention.

    • Main Results:

    • Mortality is significantly influenced by age, cecal diameter, delay in decompression, and bowel status.
    • The risk of colonic perforation escalates with cecal diameter >12 cm and distention >6 days.
    • Mortality approaches 40% in cases with ischemia or perforation.

    Conclusions:

    • Prompt diagnosis and management of ACPO are essential for reducing morbidity and mortality.
    • Management strategies involve supportive care, selective use of neostigmine, and colonoscopic decompression.
    • Vigilance for complications like perforation and ischemia is crucial in high-risk patients.