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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.
Acute colonic pseudo-obstruction (ACPO) is common in polytrauma patients, especially older males. Risk factors include shock, severe injuries, pelvic fractures, and opioid use, necessitating vigilant monitoring for better outcomes.
Area of Science:
- Trauma Surgery
- Gastroenterology
- Surgical Critical Care
Background:
- Acute colonic pseudo-obstruction (ACPO) presents as severe colonic distension without mechanical blockage, posing diagnostic challenges.
- Its pathogenesis in polytrauma patients remains unclear, highlighting a need for further investigation.
Purpose of the Study:
- To investigate the risk factors and clinical outcomes associated with ACPO in polytrauma patients.
- To contribute valuable data to the limited existing literature on ACPO in this specific patient population.
Main Methods:
- A retrospective analysis of data from a Level 1 trauma center (July 2009-June 2018) involving patients with ACPO and a control group.
- Statistical analyses, including logistic regression, were used to identify significant risk factors and associations.
Main Results:
- ACPO incidence was 1.7 per 1,000 patients, increasing to 4.86 in major trauma cases, predominantly affecting males over 50.
- Key associated factors included shock index >0.9, Injury Severity Score >18, opioid use, retroperitoneal bleeds, and pelvic fractures.
- A cecal diameter of ≥12 cm was linked to increased risk of cecal ischemia or perforation.
Conclusions:
- ACPO is a significant condition in polytrauma, with identified risk factors and clinical outcomes.
- High clinical suspicion is advised for older patients with specific injuries and opioid use; early management is crucial.
- Further prospective research is needed to validate findings and improve understanding of ACPO in trauma care.
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