Acute Colonic Pseudo-Obstruction with Feeding Intolerance in Critically Ill Patients: A Study according to Gut Wall Analysis

Abstract

Objective. To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening. Methods. ACPO patients with feeding tolerance were divided into ACPO with no obvious gut wall thickening (ACPO-NT) group and ACPO with obvious acute gut wall thickening (ACPO-T) group according to computed tomography and abdominal radiographs. Patients' condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared. Results. Patients in ACPO-T group had a significantly higher APACHE II (11.82 versus 8.25, p = 0.008) and SOFA scores (6.47 versus 3.54, p < 0.001) and a significantly higher 28-day mortality (17.78% versus 4.16%, p = 0.032) and longer intensive care unit stage (4 versus 16 d, p < 0.001). Patients in ACPO-NT group were more likely to be responsive to supportive treatment (62.50% versus 24.44%, p < 0.001), neostigmine (77.78% versus 17.64%, p < 0.001), and colonoscopic decompression (75% versus 42.86%, p = 0.318) than those in ACPO-T group. Of the patients who underwent ileostomy, 81.25% gained benefits. Conclusions. ACPO patients with gut wall thickening are more severe and are less likely to be responsive to nonsurgical treatment. Ileostomy may be a good option for ACPO patients with gut wall thickening who are irresponsive to nonsurgical treatment.

Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms

“…It is also clear that a categorical clinical definition of ACPO is needed to standardise research, and improve the quality of published evidence. Distinct subtypes of ACPO have recently been proposed according to gut wall thickness on cross-sectional imaging[ 148 ], and further work should investigate the aetiology and prognostic significance of this phenomenon.…”

Acute Colonic Pseudo-Obstruction Caused by Dexmedetomidine: A Case Report and Literature Review

“…In patients with intestinal lumen of <12 cm, conservative measures should be attempted first with correction of electrolyte imbalance and avoidance of opioids, anticholinergic medications, and calcium channel blockers. Adequate fluids resuscitation, early ambulation, and knee to chest or prone positioning to promote flatus have been recommended [ 15 ].…”

“…Prognosis of patients with this condition depends on the severity of comorbidities and clinical status and predisposing factors. The diameter of the colon is important, larger diameters poses more risk for perforation [ 4 , 11 , 15 ]. Recently, Zhao and colleges demonstrated the relation between colonic wall thickness and poor outcomes; in general, nonsurgical treatment in ACPO with no wall edema had higher successful rate of cure compared with patients with wall edema.…”

“…Additionally, they found worse prognosis and a higher rate of complications like intra-abdominal hypertension, acute compartment syndrome, sepsis, gastrointestinal hemorrhage, necrosis, and perforation among patients with colon wall edema compared to those without it. Overall mortality ranges from 14–40%, with higher mortality seen in those patients with cecal perforation [ 3 , 4 , 15 , 17 , 19 – 22 ].…”

Update S3-Leitlinie Intestinale Motilitätsstörungen: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM)

“…Empfohlen wird die supportive Therapie für alle Patienten (orale Nahrungskarenz, Korrektur von Störungen des Flüssigkeits- und Elektrolythaushalts, Magensonde, rektale Sonde zum Ableiten von Gasen, möglichst Reduktion/Weglassen von motilitätshemmenden Medikamenten, möglichst weitgehende Mobilisation des Patienten) 78 79 . Sie führt bei der Mehrzahl zur erfolgreichen Behandlung des Krankheitsbildes 132 133 , was mittlerweile auch durch eine prospektive Studie belegt wird 133 . Besonders Patienten mit normaler Kolonwanddicke sprechen in weit mehr als 50 % der Fälle auf die unspezifische konservative Therapie an 133 .…”