Acute colonic pseudo-obstruction: a syndrome due to many causes

Caroselli, Costantino; Soardi, Gian Alberto; Zaccaria, Eleonora; Bruno, Guglielmo

doi:10.1007/s11739-019-02190-5

Cited by 2 publications

(8 citation statements)

References 18 publications

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“…5 Success of nonoperative management ranges from 20% to 92%. 4 Neostigmine is a short-acting cholinesterase inhibitor, which acts as a parasympathomimetic in the GI tract. 1 Patients should have continuous cardiac and respiratory monitoring as the most common side effect is bradycardia.…”

Section: Management Medical Managementmentioning

confidence: 99%

“…2 There is a theoretical increased risk of perforation with colonoscopy in ACPO (up to 2%) given the inability of the patient to undergo a bowel prep and the risks of insufflation in an already dilated colon. 1,2,4 However, studies demonstrate that the 30-day all-cause mortality for colonic decompression was 8.4% compared with 14.8% in the standard medical therapy group. 7 Percutaneous endoscopic cecostomy is an option for patients who are poor surgical candidates and can be done under conscious sedation with colonoscopic and…”

Section: Management Medical Managementmentioning

confidence: 99%

“…Serial imaging studies should be obtained to determine the rate of colonic distention and cecal diameter. 4 Although it may be safe to continue medical management at 48 to 72 hours in patients who are clinically stable without evidence of ischemia or perforation, waiting ≥6 days is associated with perforation. 1 Patients who fail nonoperative management but who do not have ischemia or perforation requiring resection may benefit from operative cecal decompression.…”

Section: Surgical Managementmentioning

confidence: 99%

“…5 Onset of action is a median of 4 minutes with a duration of action 20 to 30 minutes. 4 Neostigmine has an initial success rate of 60% to 94%, with a recurrence rate of 0% to 31%. 1,2 If no initial response is seen in the first 3 hours or if the patient develops recurrent ACPO symptoms, a second dose of neostigmine may be given, or endoscopic decompression may be considered.…”

Section: Managementmentioning

confidence: 99%

“…1 The diagnosis may be difficult to determine, as ACPO may occur in critically ill patients, in postoperative patients, or because of other contributing factors that include prolonged immobilization, high dosages of opioids, sepsis, and electrolyte abnormalities. 4 Initial evaluation should include a focused history and physical examination as well as laboratory testing and diagnostic imaging. 2 Patients may present with crampy abdominal pain, nausea, vomiting, and abdominal distention.…”

Section: Presentation and Diagnosismentioning

confidence: 99%

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Acute Colonic Pseudo-Obstruction

Westfall

Cleary

2022

Diseases of the Colon &Amp; Rectum

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A 33-year-old man with a history of chronic alcohol use, generalized anxiety disorder, and hypertension presented to the emergency department after a syncopal event. He was admitted to the medical intensive care unit for alcohol withdrawal, requiring intubation and sedation. On hospital day 7, abdominal x-ray image demonstrated a dilated cecum to 12 cm, transverse colon dilation to 7 cm, and decompressed distal colon (Fig. 1). CT scan of the abdomen and pelvis confirmed dilation of the cecum and ascending and transverse colons (Fig. 2). Colonoscopy showed no evidence of distal obstruction, but colonic distension persisted, and he subsequently underwent cecal decompression with an open "blow-hole" cecostomy fully matured at skin level via a small right lower quadrant incision. The nasogastric tube was removed on postoperative day 2, and his diet was slowly advanced. Abdominal x-ray image on postoperative day 5 demonstrated no colonic dilation. He was discharged home on postoperative day 7. The patient re-presented to the hospital 3 months later with cecostomy prolapse. He underwent cecostomy takedown with ileocecectomy via circumstomal incision. He was discharged home on postoperative day 2. CLINICAL QUESTIONS/LEARNING OBJECTIVES1. How does Ogilvie syndrome (acute colonic pseudoobstruction) present? 2. What is the initial medical management? 3. When is surgery indicated for acute colonic pseudo-obstruction?Earn Continuing Education (CME) credit online at cme.lww.com. This activity has been approved for AMA PRA Category 1 credit. TM Funding/Support: None reported.

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Section: Management Medical Managementmentioning

confidence: 99%