Giant colonic volvulus due to colonic pseudo-obstruction

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Internal Medicine

Background:

• Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, presents as significant colonic dilation.
• It is characterized by impaired gastrointestinal propulsion, mimicking symptoms of intestinal obstruction.
• ACPO occurs without any anatomical obstruction within the intestinal lumen.

Observation:

• Gross dilation of the caecum and right hemicolon is a hallmark of ACPO.
• This dilation may extend to the sigmoid colon and rectum in some cases.
• Clinical presentation strongly suggests intestinal obstruction.

Findings:

• ACPO is distinguished by a lack of intrinsic luminal pathology.
• Differential diagnosis must exclude mechanical bowel obstruction and toxic megacolon.
• The condition can predispose to or mimic colonic volvulus, particularly in elderly patients.

Implications:

• Accurate diagnosis of ACPO is crucial to avoid unnecessary surgical interventions for presumed mechanical obstruction.
• Understanding ACPO's pathophysiology aids in appropriate management strategies.
• Recognition of ACPO's association with volvulus, especially in geriatric populations, is vital for timely intervention.