[Treatment of colectasia occurring in intensive care]

Acute false colonic obstruction occurred in one female and nine male patients aged between 51 and 82 years. They had been admitted to an intensive care unit for respiratory failure (thoracic trauma, pneumonia, chronic or postoperative respiratory failure, or neurological disease). Three patients were in terminal multiple organ failure. There was an associated potassium deficiency in six of the patients. Mechanical ventilatory support was required in eight patients. Plain abdominal X-rays showed caccal diameters greater than 8 cm, confirming the diagnosis. All these patients were initially treated with nasogastric suction, intravenous fluids, potassium replacement, but without success, except in one patient. One spontaneous caecal perforation and a case of impending perforation were treated surgically without prior endoscopy. Nine colonoscopies were carried out with great difficulties. Immediate colic deflation was achieved, but the colic distension resumed 24 h later in six patients. Normal bowel function restarted after colonoscopy in one patient, whilst another one perforated. The air introduced during colonoscopy in the already distended bowel may have speeded up the perforation. Surgery (caecostomy or colostomy) was followed by a return to normal bowel function in seven out of eight patients. One patient died as a result of his spontaneous caecal perforation; the death of three other patients was due to the underlying disease. Ogilvie's syndrome occurring in intensive care patients requires colonic decompression to avoid perforation. Colonoscopy helps to rule out true anatomic occlusion and confirms the diagnosis. However, it is often difficult to carry out, poorly efficient and sometimes dangerous.(ABSTRACT TRUNCATED AT 250 WORDS)