Therapeutic colonoscopy in the treatment of colonic pseudo-obstruction

Colonic pseudo-obstruction has been recognized since Ogilvie described this disease in 1948. Metabolic, surgical, and medical causes have been implicated at various times. Treatment has included surgical decompression by cecostomy and colectomy. Successful nonoperative decompression by colonoscopy was first reported by Kukora and Dent in 1977. Since that report several authors have reported their results using this technique. Presented here is a series of nine patients with colonic pseudo-obstruction treated initially with colonoscopy. Patients presented with a variety of associated conditions, including post operative patients, orthopedic injuries, metastatic carcinoma, and an unusual case after a normal vaginal delivery. Eight patients responded well to colonoscopic decompression. One patient, the second in the series, was unable to be decompressed with colonoscopy and underwent a cecostomy under local anesthesia. Successive colonoscopy may be required to allow restoration of normal colonic function, as was the case in seven of our patients. One death occurred, due to unrelated causes. The authors have found colonoscopy to be a safe and reliable therapy for colonic pseudo-obstruction.