Epidemiology
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Etiologic/Risk Factors
- Aerophagia
- Electrolyte Abnormality
- Medications Which Impair Colonic Motility
- Sepsis (see Sepsis, [[Sepsis]])
Physiology
- Acute Marked Colonic Distention in the Absence of Defined Mechanical Pathology
- May be referred to as “colonic Ileus”: however, pseudo-obstruction is limited to the colon alone (while ileus affects both the small bowel and the colon)
- Pseudo-osbtruction may affect the right colon
- Note: this is distinct from chronic intestinal pseudo-obstruction (see Chronic Intestinal Pseudo-Obstruction, [[Chronic Intestinal Pseudo-Obstruction]])
Diagnosis
- KUB: isolated proximal colonic dilatation
- Abdominal/Pelvic CT: isolated proximal colonic dilatation
Clinical Differentiation of Similar Entities
|Ileus|Pseudo-Obstruction|Bowel Obstruction
:————-:|:————-:|:———–:
Symp-toms|Mild abdominal pain, bloating, nausea, vomiting, obstipation, constipation|Crampy abdominal pain, constipation, obstipation, nausea, vomiting, anorexia|Crampy abdominal pain, constipation, obstipation, nausea, vomiting, anorexia
Exam|Silent abdomen, distention, tympanic|Borborygmi, tympanic, peristaltic waves, hypoactive or hyperactive bowel sounds, distention, localized tenderness|Borborygmi, peristaltic waves, high-pitched bowel sounds, rushes, distention, localized tenderness
X-Ray|Large and small bowel dilatation, diaphragm elevated|Isolated large bowel dilatation, diaphragm elevated|Bow-shaped loops in ladder pattern, paucity of colonic gas distal to lesion, diaphragm mildly elevated, air-fluid levels
Clinical Manifestations
Gastrointestinal Manifestations
- Abdominal Distention: without abdominal pain or tenderness
- Symptoms may mimic bowel obstruction
- Colonic Ischemia (see Colonic Ischemia, [[Colonic Ischemia]])
- Colonic Perforation (see Colonic Perforation, [[Colonic Perforation]])
Other Manifestations
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Treatment
Medical Therapy
- Colonoscopic Decompression: effective
- Correction of Electrolyte Abnormalities
- Discontinuation of Medications Which Impair Bowel Motility
- Intravenous Fluid Hydration
- Nasogastric Tube: recommended
- Neostigmine (see Neostigmine, [[Neostigmine]])
- Administration: 2.5 mg IV over 3 min (with cardiac monitoring for bradycardia)
- Adverse Effects
- Bradycardia (see Bradycardia, [[Bradycardia]]): treat with atropine (see Atropine, [[Atropine]])
- Clinical Efficacy: may result in resolution of pseudo-obstruction within 10-30 min
- Rectal Tube: recommended
Surgical Therapy
- Laparotomy with Bowel Resection/Ostomy: considered a last resort, but may be required in cases with bowel ischemia/peritonitis
Prognosis
- Mortality Rate: 50% in cases with colonic ischemia/perforation
References
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