ABSTRACT

Purpose:

Acute colonic pseudo-obstruction (ACPO) is a rare clinical entity characterised by colonic obstruction without the presence of any mechanical cause. The aim of this study to present of the clinical presentation, management and outcome of 12 patients with ACPO.

Patients and Methods:

The records of 15 patients with ACPO who treated in our clinic between 1998-2007 were retrospectively reviewed with respect to gender, age, associated medical problems, symptoms, signs, treatments, and outcomes of treatments.

Results:

Mean age of the patients was 63.7 years and female/male ratio was 5/7. Among them, 8 (66.7%) had additional medical problems. The most common symptoms were abdominal pain and distention, while the most common signs were abdominal tenderness and distention. Mean cecal diameter was 11.5 cm in plain abdominal Xray films. The initial treatment was conservative in all patients and complete resolution was achieved in 8 (66.7%) of patients. Two patients were treated successfully with intravenous neostigmine. Two patients were treated with eritromicine; a success rate of 50%. Intraabdominal pressure increased dramatically (28 mmHg) and diameter of cecum reached approximately 25 cm in the patient who complete resolution was not achieved using eritromicin and right hemicolectomy was required urgently. This patient died in 5th postoperative day due to respiratory reasons.

Conclusions:

The initial treatment of ACPO is conservative, a success rate of 66.7%. Other therapies include mainly parasymphatomimetic drugs and/or colonoscopic decompressions. Surgical treatment is needed i) when further therapies such as parasymphatomimetic drugs or colonoscopic decompressions following conservative managements are unsuccessful, ii) when cecal ischemia, necrosis, or perforation is suspected, iii) when life-threating abdominal compartment syndrome developed during conservative therapy.