Cecal pseudo-obstruction. Early therapy should be nonoperative

This study was undertaken to ascertain the role of colonoscopy and surgery in patients with pseudo-obstruction of the cecum. Twenty-eight patients developed cecal pseudo-obstruction (cecal diameter ave., 13.6 cm +/- 2.0; range, 10-18 cm) and 25 of these 28 (89%) were hospitalized for nonabdominal problems. Significant comorbidities existed in all patients. Multimodal therapy was used in most: nasogastric (NG) suction (100%), rectal tube (64%), laxatives (64%), enemas (57%), Colonoscopy (57%), and surgery (25%). Twelve of 18 patients receiving rectal tubes, 14 of 18 receiving laxatives, 11 of 16 receiving enemas, and 12 of 16 (75%) undergoing colonoscopy avoided surgery; colonoscopy cured 44 per cent of the patients, was useless in 38 per cent, was detrimental in 6 per cent, and was temporizing in 12 per cent. Seven of the 28 patients (5 cecostomy, 2 right hemicolectomy) underwent surgery. Four of the seven patients (57%) had significant surgical complications such as wound infection, incisional hernia, cecal prolapse with infarction/death, and evisceration/death. Twenty-four patients of the 28 (86%) survived the index admission; Two of four patients died of the systemic problems that brought on cecal pseudo-obstruction and two of four patients died as a result of cecostomy complications. Pseudo-obstruction occurs in older, debilitated patients generally hospitalized because of nonabdominal problems. Treatment should be aimed at correcting the underlying cause; multimodalities often temporize until underlying problems are corrected and pseudo-obstruction resolves. Colonoscopy is often curative, occasionally helpful, and rarely harmful. Surgery is curative but carries significant risks. Uncomplicated cecal dilatation to 10-18 cm is tolerated; early operative intervention should not be dictated by cecal size alone.