Acute Colonic Pseudo-obstruction and Volvulus: Pathophysiology, Evaluation, and Treatment

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• Acute colonic pseudo-obstruction (ACPO) and volvulus are significant causes of colonic distension.
• ACPO is linked to comorbidities, infections, and cardiac issues, while volvulus commonly affects the sigmoid colon or cecum.

Purpose of the Study:

• To outline the distinct characteristics and management strategies for ACPO and colonic volvulus.
• To highlight the critical need for timely intervention to prevent severe complications.

Main Methods:

• Review of clinical presentations and established treatment protocols for ACPO and colonic volvulus.
• Analysis of outcomes associated with conservative and surgical management approaches.

Main Results:

• ACPO management includes conservative options like endoscopic decompression or neostigmine, with potential for high mortality if peritonitis develops.
• Sigmoid volvulus may be managed endoscopically, but sigmoid colectomy is recommended; cecal volvulus necessitates right hemicolectomy.

Conclusions:

• Prompt diagnosis and appropriate management, whether conservative or surgical, are crucial for improving outcomes in ACPO and colonic volvulus.
• Understanding the specific disease process and location is key to selecting the optimal therapeutic strategy.