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Acute Colonic Pseudo-Obstruction.

Thomas Arthur1,2,3, Adele Burgess1,4

  • 1Department of Colorectal Surgery, Austin Hospital, Melbourne, Australia.

Clinics in Colon and Rectal Surgery
|August 15, 2022
PubMed
Summary

Acute colonic pseudo-obstruction (ACPO) is a functional disorder causing colonic distension without blockage. Management includes conservative measures, decompression, and consideration of underlying motility disorders for recurrent cases.

Keywords:
Ogilvie's syndromeacute colonic pseudo-obstructioncolonic ileuslarge bowel obstruction

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Area of Science:

  • Gastroenterology
  • Surgical Emergencies
  • Colorectal Surgery

Background:

  • Acute colonic pseudo-obstruction (ACPO) is a functional disorder characterized by colonic dysmotility and distension without mechanical obstruction.
  • The precise pathophysiology of ACPO is not fully understood despite advancements in motility research.
  • Current management strategies for ACPO have seen limited changes over the past four decades.

Purpose of the Study:

  • To provide a concise update on the causes, diagnosis, and management of acute colonic pseudo-obstruction.
  • To highlight current treatment approaches for ACPO, including conservative and interventional methods.
  • To discuss considerations for patients with recurrent ACPO and potential underlying functional disorders.

Main Methods:

  • Review of existing literature on acute colonic pseudo-obstruction.
  • Analysis of diagnostic criteria and current management protocols for ACPO.
  • Discussion of surgical and non-surgical interventions for ACPO.

Main Results:

  • ACPO management involves operative intervention for perforation/ischemia, conservative care for others, and decompression (neostigmine or colonoscopy) for refractory cases.
  • Recurrent ACPO may indicate underlying functional disorders like slow-transit dysmotility or chronic intestinal pseudo-obstruction.
  • Despite technological advances, ACPO pathophysiology remains unclear.

Conclusions:

  • ACPO is an emergency surgical condition requiring timely diagnosis and management.
  • Conservative management and decompression are primary strategies, with consideration for underlying motility disorders in complex cases.
  • Further research into ACPO pathophysiology is needed to refine treatment approaches.