Acute and chronic pseudo‐obstruction: a current update

Abstract

Acute colonic pseudo-obstruction (ACPO) and chronic intestinal pseudo-obstruction (CIPO) are distinct clinical entities in which patients present similarly with symptoms of a mechanical obstruction without an occlusive lesion. Unfortunately, they also share the issues related to a delay in diagnosis, including inappropriate management and poor outcomes. Advancements have been made in our understanding of the aetiologies of both conditions. Several predisposing factors linked to critical illness have been implicated in ACPO. CIPO is a functional motility disorder, historically misdiagnosed, with unnecessary surgery being performed in many patients with dire consequences. This review discusses the pathophysiology, clinical and diagnostic features, and treatment of each. For ACPO, a safer pharmacological approach to treatment is presented in a modified up-to-date algorithm. The importance of CIPO as a differential diagnosis when seeing patients with recurrent admissions for abdominal pain and distention is also discussed, as well as specific indications for surgery. While surgery is often a last resort, the role of the surgeon in the management of both ACPO and CIPO cannot be undervalued. By characterizing each condition in a common review, the knowledge gleaned aims to optimize outcomes for these frequently complex patients.

Acute colonic pseudo-obstruction associated with abdominal paracentesis

“…Had no improvement in symptoms or signs been seen in 48 hours, then we could have considered using antimuscarinic neostigmine 3 5. Endoscopic decompression is superior, but relies on the experience of the endoscopist 6.…”

“…Endoscopic decompression is superior, but relies on the experience of the endoscopist 6. Failure of medical and endoscopic decompression, or signs of bowel ischaemia or perforation, are indications for surgery 2 3 4…”

“…It mimics colonic obstruction, but lacks a mechanical cause. It has been found to be associated with a wide range of conditions, including major surgery, Caesarean sections and systemic sepsis 3 4…”

Strategy to reduce bortezomib-induced paralytic ileus in patients with myeloma and impaired renal function

“…6 We propose that bortezomib be added to this list, particularly in the setting of renal impairment. We believe that the hypercalcaemia in case 1 and the opiate use/hypokalaemia/hypomagnesemia in case 2 had a cumulative effect on the patients' paralytic ileus.…”

“…Adapted with permission from Bernardi et al 6. Surgical risk factors are not included in this table.…”