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Published on: July 12, 2018
Acute colonic pseudo-obstruction in polytrauma patients
Cecil S Johnny1, Richard N Schlegel, Mayurathan Balachandran
1From the Trauma Service (C.S.J., R.N.S., M.B., L.C., J.M., E.-J.B., M.C.F.), Emergency and Trauma Centre (C.S.J., J.M.), and National Trauma Research Institute (C.S.J., J.M., E.-J.B., M.C.F.), The Alfred Hospital; Department of Surgery (C.S.J., J.M., M.C.F.), Central Clinical School, Monash University; Colorectal Unit, Department of Surgery (P.C.), Department of Radiology (D.V.), and Acute General Surgery Unit (E.-J.B.), The Alfred Hospital, Melbourne, Victoria, Australia.
Background:
Acute colonic pseudo-obstruction (ACPO) is characterized by severe colonic distension without mechanical obstruction. It has an uncertain pathogenesis and poses diagnostic challenges. This study aimed to explore risk factors and clinical outcomes of ACPO in polytrauma patients and contribute information to the limited literature on this condition.
Methods:
This retrospective study, conducted at a Level 1 trauma center, analyzed data from trauma patients with ACPO admitted between July 2009 and June 2018. A control cohort of major trauma patients was used. Data review encompassed patient demographics, abdominal imaging, injury characteristics, analgesic usage, interventions, complications, and mortality. Statistical analyses, including logistic regression and correlation coefficients, were employed to identify risk factors.
Results:
There were 57 cases of ACPO, with an incidence of 1.7 per 1,000 patients, rising to 4.86 in major trauma. Predominantly affecting those older than 50 years (75%) and males (75%), with motor vehicle accidents (50.8%) and falls from height (36.8%) being the commonest mechanisms. Noteworthy associated injuries included retroperitoneal bleeds (RPBs) (37%), spinal fractures (37%), and pelvic fractures (37%). Analysis revealed significant associations between ACPO and shock index >0.9, Injury Severity Score >18, opioid use, RPBs, and pelvic fractures. A cecal diameter of ≥12 cm had a significant association with cecal ischemia or perforation.
Conclusion:
This study underscores the significance of ACPO in polytrauma patients, demonstrating associations with risk factors and clinical outcomes. Clinicians should maintain a high index of suspicion, particularly in older patients with RPBs, pelvic fractures, and opioid use. Early supportive therapy, vigilant monitoring, and timely interventions are crucial for a favorable outcome. Further research and prospective trials are warranted to validate these findings and enhance understanding of ACPO in trauma patients.
Level Of Evidence:
Prognostic and Epidemiological; Level IV.
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