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Therapeutic and diagnostic colonoscopy in nonobstructive colonic dilatation
Annals of Surgery
|April 1, 1983
Summary
Colonoscopy effectively treats nonobstructive colonic dilatation (NCD), a condition with high mortality. This safe procedure decompresses the cecum, offering a viable alternative to surgery for patients without signs of perforation.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Endoscopy
Background:
- Cecal perforation is a serious complication of colonic obstruction or nonobstructive colonic dilatation (NCD).
- NCD carries a high mortality rate, approaching 50%, with unknown incidence.
- NCD often develops post-operatively or in patients with significant systemic disorders.
Purpose of the Study:
- To evaluate the safety and efficacy of colonoscopy in managing nonobstructive colonic dilatation.
- To assess colonoscopy as a therapeutic and diagnostic tool for massive cecal dilatation.
Main Methods:
- A retrospective analysis of 44 patients undergoing 52 colonoscopic examinations for presumed NCD over eight years.
- Patients had a mean age of 59 years; NCD was often associated with recent surgery or systemic illness.
- Colonoscopic decompression was performed, with cecal diameter measured before and after the procedure.
Main Results:
- Colonoscopy successfully decompressed the cecum in 86% of patients (mean diameter reduced from 12.8 cm to 8.7 cm).
- One patient (2%) experienced cecal perforation during colonoscopy, with survival.
- Fourteen patients died, with six deaths attributed to underlying conditions or operations, not the colonoscopy itself.
Conclusions:
- Colonoscopy is a safe and effective treatment for massive cecal dilatation due to NCD.
- It should be considered a primary intervention before cecostomy in patients lacking pneumoperitoneum or peritoneal signs.
- The procedure offers a less invasive approach with a low complication rate for this condition.