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Acute colonic pseudo-obstruction.

Michael D Saunders1

  • 1Division of Gastroenterology, Digestive Disease Center, University of Washington Medical Center, 1959 NE Pacfiic Avenue, Box 356424, Seattle, WA 98195, USA. michaels@medicine.washington.edu

Best Practice & Research. Clinical Gastroenterology
|July 24, 2007
PubMed
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Acute colonic pseudo-obstruction (ACPO) is a serious condition causing massive colon dilation in hospitalized patients. Early recognition and management, including supportive therapy and decompression, are critical for improving outcomes and reducing mortality.

Area of Science:

  • Gastroenterology
  • Internal Medicine

Background:

  • Acute colonic pseudo-obstruction (ACPO) is characterized by significant colon dilation without mechanical blockage.
  • This condition frequently affects hospitalized patients with severe underlying medical or surgical issues.
  • ACPO is linked to substantial morbidity and mortality, necessitating prompt gastroenterologic assessment.

Purpose of the Study:

  • To outline the evaluation and management of acute colonic pseudo-obstruction.
  • To identify factors influencing mortality in ACPO patients.
  • To emphasize the importance of early diagnosis and intervention.

Main Methods:

  • Review of diagnostic criteria for ACPO.
  • Assessment of differential diagnoses, including mechanical obstruction, toxic megacolon, Clostridium difficile infection, ischemia, and perforation.

Related Experiment Videos

  • Evaluation of prognostic factors such as age, cecal diameter, and duration of distention.
  • Discussion of management strategies including supportive care, neostigmine, and colonoscopic decompression.

    • Main Results:

    • Mortality approaches 40% when ischemia or perforation is present.
    • Risk of colonic perforation escalates with cecal diameter >12cm and distention duration >6 days.
    • Factors influencing mortality include patient age, cecal diameter, delayed decompression, and bowel status.

    Conclusions:

    • Early identification and management of ACPO are crucial for minimizing complications.
    • Appropriate evaluation involves excluding other causes of toxic megacolon and assessing for ischemia/perforation.
    • Management strategies encompass supportive therapy and selective interventions like neostigmine and colonoscopy for decompression.