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Massive cecal dilation: pseudoobstruction versus cecal volvulus?

H V Villar, L W Norton

    American Journal of Surgery
    |February 1, 1979
    PubMed
    Summary
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    Massive colonic ileus in elderly patients can be life-threatening. Early diagnosis and interventions like colonoscopic decompression or tube cecostomy are crucial for survival.

    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Internal Medicine

    Background:

    • Acute abdominal distension can arise from massive cecal and right colon ileus.
    • This condition is particularly noted in elderly, sick, and bedridden patients.
    • Differential diagnoses include colonic pseudoobstruction, cecal volvulus, sigmoid volvulus, and acute gastric dilation.

    Observation:

    • Seven patients with acute and progressive abdominal distension due to massive cecal and right colon ileus were analyzed.
    • Five patients presented with pseudoobstruction of the colon, and two had cecal volvulus.
    • Mortality in two patients with pseudoobstruction and one with cecal volvulus was attributed to pre-existing conditions.

    Findings:

    • Pseudoobstruction of the colon is a recognized complication in the elderly and debilitated.

    Related Experiment Videos

  • Initial conservative management is recommended when no peritoneal signs are evident.
  • Colonoscopic decompression is advised for cecal diameters exceeding 12 cm.
  • Tube cecostomy offers a curative and life-saving treatment, even with taenia splitting.
  • Resection is mandatory in cases of perforation or extensive necrosis.

    • Implications:

    • Prompt diagnosis and appropriate management of massive colonic ileus are vital for patient outcomes.
    • Non-operative interventions like colonoscopic decompression and tube cecostomy can be highly effective.
    • Surgical resection remains critical for managing complications such as perforation and necrosis.