Colonic pseudo-obstruction: an uncommon complication of caesarean section

Four cases of pseudo-obstruction following lower segment Caesarean section are presented with a review of the condition. In the first patient the diagnosis was made at laparotomy, but the other 3 were diagnosed on clinical and radiolographic grounds. Two of these subsequently required surgical caecal decompression, while only 1 was successfully managed conservatively. This is typical of the spectrum of this uncommon but well recognized syndrome which may complicate Caesarean section, vaginal delivery, hysterectomy or other gynaecological operations. When diagnosed, the initial management may be conservative, but close surveillance of caecal diameter must be maintained in order to prevent disastrous caecal rupture. When this is imminent, decompression by either colonoscopy, or laparotomy and caecostomy is indicated. With early surgical intervention, the high mortality rate for this condition can be greatly reduced.