Abstract
Acute colonic pseudo-obstruction (ACPO) is a functional disorder of the large intestine
distinguished by colonic dysmotility resulting in colonic distension in the absence
of mechanical obstruction. The underlying pathophysiology of ACPO remains unclear
despite technological advances in understanding the physiology of colonic motility,
such as spatio-temporal mapping and high-resolution manometry. In many ways, the management
of ACPO has remained relatively unchanged for 40 years. Patients with perforation
or suspected ischemia undergo operative intervention, while patients without undergo
initial conservative management with bowel rest, correction of electrolyte disturbances,
and mobilization. Patients who fail conservative management or have prominent cecal
dilatation undergo decompression with either neostigmine or colonoscopy. A subset
of patients with ACPO will have recurrent symptoms despite endoscopic and medical
management. For these patients who are difficult to manage, an underlying colonic
functional disorder, such as slow-transit dysmotility or chronic intestinal pseudo-obstruction
may be considered. The following review of ACPO aims to provide a concise update of
the causes, diagnosis, and management of this emergency surgical condition.
Keywords
acute colonic pseudo-obstruction - Ogilvie's syndrome - large bowel obstruction -
colonic ileus
