Intestinal Pseudo-obstruction

  • – Intestinal dysmotility syndrome that have signs, symptoms and the radiologic appearance of obstruction in the absence of mechanical cause
  • – Ileus: Intestinal contents are acutely unable to transit because of impairment of neural or muscular inadequacy

 

 

Acute Colonic Pasudo-obstruction / Ogilvie’s syndrome: (ACPO)

 

  • – Acute massive dilatation of the cecum and right colon with simultaneous, yet less severe dilatation of the left colon and distal small intestine without evidence of mechanical obstruction
  • – ACPO typically occurs in older (mean 60 years) men who are hospitalized or institutionalized with severe underlying medical/surgical conditions
  •                                                                                                                                                                                                                                                                                       
  • Conditions associated with ACPO:
  • – Trauma
  • – Infection (Pneumonia, Sepsis)
  • – Cardiac Disease (MI, Heart failure)
  • – Gynecologic surgery
  • – Abdominal/pelvic surgery
  • – Orthopedic surgery
  • – Neurologic conditions (Perkinson’s disease)
  • Symptoms/signs:
  • – Abdominal distension (develops over 3-7 days or within 24 hours)
  • – Nausea, Vomiting
  • – Abdominal pain:
  •                • Mild
  •                • Constant
  •                • Occasional rebound tenderness
  •  – Painless distension
  • – Features of ischemia/ Perforation
  • – New abdominal pain/ tenderness
  • – Increasing WBC
  •                             Imaging:
  • Plain x-ray abdomen:
  • – Dilatation of the colon, preferentially affecting the right colon
  • – Maximum Cecal diameter : 9-25 cm
  • – Air-fluid level can be seen in small intestine but not in the colon
  • – Haustral folds are often seen despite severe distension

 

Treatment of ACPO

 

  • Medical Decompression:
  • –   By  inj.Neostigmine if cecal diameter > 9 cm for 72 hours
  • Metochlopromide
  •                                                                                             
  • Endoscopic Decompression
  • – Colonoscopic decompression achieved in 80% patients
  • – It should be considered when conservative and pharmacologic maneuvers failed as it has high risk of perforation if done in unprepared colon
  • Percutaneous Cecostomy
  • Surgical decompression
  •             • Cecostomy
  •             •Colostomy/ Resection
  • Other Measures:
  • – Correct reversible causes (Infection, Hypovolemia,Electrolyte imbalance, Hypoxemia)
  • – Discontinue the drugs that can cause pserudo-obstruction
  • – Rectal tube if sigmoid colon is markedly dilated
  • – When the diameter of the cecum is >9 cm and has not responded to treatment withinm 72 hours after diagnosis Decompression should be performed to reduce the risk of ischemia, perforation and death

 

 


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