Acute colonic pseudo-obstruction in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Gastroenterology
• Surgical Complications

Background:

• Acute colonic pseudo-obstruction (ACPO) is a rare but serious complication following pregnancy.
• This study reviews institutional experience with postpartum ACPO to inform management strategies.

Observation:

• Seven cases of ACPO were identified from 10,240 deliveries over a two-year period.
• Two patients required surgical intervention (laparotomy); others resolved with conservative management.
• Pharmacological treatments included neostigmine and erythromycin; one patient underwent unsuccessful endoscopic decompression.

Findings:

• Postpartum ACPO occurs more frequently than previously suspected, at approximately 1 in 1500 deliveries.
• Early correction of electrolyte imbalances, avoiding narcotic analgesia, and promoting early mobilization are key management principles.
• Prompt administration of neostigmine or endoscopic decompression can mitigate risks of colonic ischemia, perforation, and surgical necessity.

Implications:

• Establishes a higher incidence of postpartum ACPO, necessitating increased clinical awareness.
• Proposes an evidence-based management algorithm to guide clinical practice.
• Highlights the benefits of non-surgical interventions in reducing morbidity and surgical rates for postpartum ACPO.