[Acute pseudo-obstruction of the colon]

Acute pseudo-obstruction of the colon is a probably often misdiagnosed type of ileus, the diagnosis of which follows from the clinical pattern with the signs of a mechanical ileus, the acute course and the x-ray signs. Radiological findings cannot be clearly interpreted without knowledge of the clinical pattern and the course of the disease. Hence, the radiological correlate of the pseudo-obstruction of the colon is not specific, but it does supply a pointer to the disease of its shows dilation of the caecum, colon ascendens and colon transversum with air-pockets and reflected imaging as well as a usually not dilated colon descendens with remarkably little air. To make the diagnosis quite sure we must exclude intestinal obstruction by using x-ray contrast media or by coloscopy. Early diagnosis is important because of the danger of perforation of the massively dilated colon (lethality up to 60%) and good prognosis if therapy is initiated in time via compression by a Dennis sound (success rate 90%). To control the success of the treatment there must be a 24-hour x-ray follow-up to avoid the risk of perforation of the colon. In this manner it becomes possible to spare the usually elderly and multimorbid patients an operation at an enhanced risk.