Update on acute colonic pseudo-obstruction

Abstract

Acute colonic pseudo-obstruction is characterized by distention of the colon in the absence of mechanical obstruction. This presentation is typically related to recent surgery, severe illness, or medication. Nasogastric and rectal tube decompression and correction of electrolyte abnormalities are the standard of care. Colonoscopic decompression, performed in a number of these cases, was felt to be unwarranted in many situations and is associated with a high recurrence rate. Medical management beyond conservative measures has been limited. Medical therapy with pharmacologic agents such as erythromycin, metoclopromide, and cisapride was of limited use. Recent findings confirm that an older agent, neostigmine, provides excellent results, including colonic decompression and clinical improvement after administration. This suggests a new standard of care.

Paralytic Ileus in the Orthopaedic Patient

“…42 Surgery is associated with a high mortality rate; thus, it should be considered as a measure of final resort and in cases of bowel perforation. Recurrence of dilation after endoscopic decompression approaches 40%.…”

The demise of the instant/unprepared contrast enema in large bowel obstruction

“…If necessary this can be carried out either as an emergency if a suitable interventional Radiologist is available or on the next days interventional list. Such stents can be used as a one‐stop procedure in those patients who are not fit for surgery or as a bridge to surgery in patients who may be suitable for resection in order to avoid a temporary colostomy [ 12–14].…”

The role of colonoscopy in the management of intestinal obstruction: a 20-year retrospective study

“…Non-operative measures include pharmacologic colonic decompression combined with general measures [8-14] and digestive colonoscopy. Diagnostic colonoscopy in the involvement of the large intestine or enteroscopy in the case of incomplete obstruction of the small intestine is the method indicated in the majority of obstructive intestinal lesions [15].…”