Pseudo-obstruction of the colon

Psuedo-obstruction of the colon is a potentially lethal condition. The diagnosis should be suspected in a patient with derangement of a major extra-abdominal organ system in whom abdominal distention develops. Diagnosis is established by plain abdominal roentgenograms, signoidoscopy, and barium enema examination. The salient features of these examinations are as follows: (1) massive gaseous distention of the cecum and variable distances of the distal colon to a "cut-off-point"; (2) lack of fluid-filled colon; (3) normal sigmoidoscopy; and (4) barium enema examination, which rules out mechanical obstruction, volvulus, and mesenteric vascular ischemia. If the diameter of the cecum is less than 12 cm, conservative therapy is indicated but persistence of the distention or cecal diameter greater than 12 cm is an absolute indication for cecostomy. Perforation must be treated by cecostomy or colectomy depending on the amount of colon necrosis.