Practical Gastroenterology and Hepatology Board Review Toolkit by

Language: eng
Format: azw3
ISBN: 9781118829080
Publisher: Wiley
Published: 2016-07-21T04:00:00+00:00

CHAPTER 58

Acute Colonic Pseudo-obstruction

Michael D. Saunders

Division of Gastroenterology, University of Washington Medical Center, Seattle, WA, USA

Summary

Acute colonic pseudo-obstruction (ACPO) is a syndrome of massive dilation of the colon without mechanical obstruction that typically develops in hospitalized patients with serious underlying medical and surgical conditions. ACPO is associated with significant morbidity and mortality, and therefore requires urgent gastroenterologic evaluation. Appropriate evaluation of the markedly distended colon involves excluding mechanical obstruction and assessing for signs of ischemia and perforation. Increasing age, cecal diameter, delay in decompression, and status of the bowel significantly influence mortality. Appropriate management includes supportive therapy and selective use of neostigmine and colonoscopy for decompression. Early recognition and management are critical in minimizing complications.

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