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Colonic pseudo-obstruction

  • Often also referred to as Olgilvie's syndrome
  • A condition characterised by reduced colonic mobility and dilatation
  • Presents with symptoms and signs of large bowel obstruction
  • Diagnosis is confirmed by single contrast enema
  • Excludes obstruction lesion
  • Often precipitated by other medical or surgical conditions including
    • Chest infection
    • Myocardial infarction
    • Cerebrovascular accident
    • Renal failure
    • Puerperium
    • Abdominal malignancy
    • Orthopaedic trauma
    • Myxoedema
    • Electrolyte disturbances

colonic pseudo-obstruction

Picture provided by Airton Rodrigues, Ana Costa General Hospital, Sao Paulo, Brazil

Management

  • Remove precipitating causes
    • Stop anticholinergics drugs
    • Reduce the use of opiates
    • Correct electrolyte disturbances
  • Decompress colon with
    • Flexible sigmoidoscopy or flatus tube
    • The cautious use of enemas
    • Intravenous neostigmine
  • Consider surgery if failure of conservative management
  • Options include:
    • Tube caecostomy
    • Resection with end ileostomy and mucus fistula

Bibliography

Dorudi S,  Berry A R,  Kettlewell M G W.  Acute colonic pseudo-obstruction.  Br J Surg 1992;  79:  99-103.

Ponec R J,  Saunders M D,  Kimmey M B.  Neostigmine in the treatment of acute colonic pseudo-obstruction.  N Eng J Med 1999;  341:  137-141.

 
 

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