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Cecal pseudo-obstruction. Early therapy should be nonoperative
1Department of Surgery, University of South Florida, Tampa 33606.
The American Surgeon
|January 1, 1990
Summary
Colonoscopy can cure cecal pseudo-obstruction in 44% of patients, offering a less invasive option than surgery. Surgery for this condition carries significant risks, making conservative management preferable when possible.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Colorectal Surgery
Background:
- Cecal pseudo-obstruction affects debilitated patients, often hospitalized for non-abdominal issues.
- These patients typically have significant comorbidities.
- Dilatation of the cecum up to 18 cm can occur without immediate surgical indication.
Purpose of the Study:
- To evaluate the efficacy of colonoscopy and surgery in managing cecal pseudo-obstruction.
- To compare the outcomes and complication rates of different treatment modalities.
Main Methods:
- Retrospective analysis of 28 patients with cecal pseudo-obstruction.
- Review of multimodal therapies including nasogastric suction, rectal tubes, laxatives, enemas, colonoscopy, and surgery.
- Assessment of treatment success, complications, and mortality.
Main Results:
- Colonoscopy cured 44% of patients, was useless in 38%, detrimental in 6%, and temporizing in 12%.
- Surgery was avoided in 75% of patients treated with colonoscopy and other multimodal therapies.
- Seven patients underwent surgery (5 cecostomy, 2 hemicolectomy) with a 57% complication rate; two died from surgery-related complications.
Conclusions:
- Treatment should focus on the underlying cause of pseudo-obstruction.
- Multimodal therapies can temporize the condition until the primary issue is resolved.
- Colonoscopy is often curative and less risky than surgery for cecal pseudo-obstruction.