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Acute colonic pseudo-obstruction. Current diagnosis and management
J E Krige1, D A Hudson, R E Kottler
1Department of Surgery, University of Cape Town.
Summary
Acute colonic pseudo-obstruction, often following illness or surgery, requires prompt diagnosis. Urgent decompression is advised for persistent distension, large caecal diameter, or tenderness to prevent perforation.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- Acute colonic pseudo-obstruction (ACPO) presents as gross abdominal distension.
- ACPO commonly follows severe systemic illness, major surgery, or trauma.
- Radiological findings include disproportionate caecal and proximal colon dilatation with reduced distal gas.
Purpose of the Study:
- To review the diagnosis and management of acute colonic pseudo-obstruction.
- To identify indicators for urgent decompression and recommend appropriate procedures.
Main Methods:
- Retrospective analysis of 29 patients with ACPO over 6 years.
- Diagnosis confirmed via contrast enema, colonoscopy, or laparotomy.
- Treatment strategies included conservative management, colonoscopic decompression, and surgical intervention.
Main Results:
- Contrast enema excluded mechanical obstruction in 24 cases.
- Colonoscopic decompression was successful in 2 of 4 patients.
- Laparotomy was performed in 8 patients; 3 of 4 with caecal perforation died.
- Conservative treatment resulted in 2 deaths among 21 patients.
Conclusions:
- Persistent colonic distension beyond 72 hours, caecal diameter >12 cm, or tenderness necessitates urgent decompression.
- Caecostomy is recommended for non-perforated ACPO.
- Early recognition and intervention are crucial to minimize perforation risk.