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Colonic Pseudo-Obstruction

Colonic Pseudo Obstruction


Presentation

  • Acute colonic pseudo-obstruction rarely presents in children. Upon diagnosis, initiating conservative management and identification of an underlying etiology is mandatory.[ncbi.nlm.nih.gov]
  • A brief review of the current literature is presented with respect to the case report.[ncbi.nlm.nih.gov]
  • The risk of colonic perforation in ACPO increases when cecal diameter exceeds 12 cm and when the distention has been present for greater than 6 days.[ncbi.nlm.nih.gov]
  • The risk of colonic perforation in ACPO increases when cecal diameter exceeds 12cm and when the distention has been present for greater than 6days.[ncbi.nlm.nih.gov]
  • Increasing age, cecal diameter, delay in decompression, and status of the bowel significantly influence mortality, which is approximately 40% when ischemia or perforation is present.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Gastrointestinal symptoms such as nausea, abdominal pain, and diarrhea without fever are common in patients treated with mycophenolate mofetil.[ncbi.nlm.nih.gov]
  • CONCLUSION: In children presenting with abdominal pain and constipation following chemotherapy, imaging features of progressive colonic dilatation seen on radiography and dilatation from the caecum to the transverse colon with the transition zone near[ncbi.nlm.nih.gov]
  • A few days after admission, abdominal pain with marked abdominal distention developed. There was no fever or leukocytosis.[nejm.org]
  • Although she had not any abdominal pain firstly. Therefore she was treated with Disodium phosphate. After than; she developed abdominal pain which is into colicky at POD 2. Although, she had passed flatus and had no vomiting.[austinpublishinggroup.com]
Abdominal Distension
  • Abdominal distension and pain were the commonest symptoms, followed by vomiting. Fever was common in patients with perforation.[ncbi.nlm.nih.gov]
  • KEYWORDS: Abdominal Distension; Colonic Dilatation; Colonic Pseudo-obstruction; Transition Zone[ncbi.nlm.nih.gov]
  • He presented as an emergency with severe abdominal distension, abdominal tenderness and vomiting. An emergency laparotomy revealed colonic dilatation and a defunctioning ileostomy was created.[ncbi.nlm.nih.gov]
  • Patients typically present with abdominal distension, pain, and altered bowel movements. Progression of disease can lead to colonic ischemia and perforation.[ncbi.nlm.nih.gov]
  • The main manifestations were vomiting, severe colicky pain, and abdominal distension. These can occur immediately after or within 2 days of the operation.[ncbi.nlm.nih.gov]
Increased Abdominal Girth
  • Patient had progressively increasing abdominal girth and plain radiograph after 12 hours showed increased cecal diameter more than 12 cm. He was given injection Neostigmine 2.0 mg intravenously slowly in stroke unit with monitoring of vital signs.[ijccm.org]
Drooling
  • We report an unusual case of colonic pseudo-obstruction in an 8-year-old child with cerebral palsy and long-term hypomotility issues being treated for drooling with the anticholinergic medication trihexyphenidyl.[ncbi.nlm.nih.gov]
Palpitations
  • A 62-year-old female who had undergone right hemicolectomy for splenic flexure syndrome caused by idiopathic megacolon was referred to our hospital with relapse, experiencing palpitation and abdominal fullness.[ncbi.nlm.nih.gov]
Skin Lesion
  • Breast Ductal and Lobular Origin 1509 Breast Carcinoma Stages I and II 1523 Locally Advanced Breast Cancer 1541 Metastatic Carcinomas of the Breast 1551 Reconstruction of the Breast 1563 Skin Soft Tissues 1569 Evaluation of Malignant and Premalignant Skin[books.google.com]
Dysmenorrhea
  • We describe the presentation and management of ACPO in a patient who underwent uncomplicated total laparoscopic hysterectomy to treat menorrhagia and dysmenorrhea after declining conservative treatment.[ncbi.nlm.nih.gov]

Workup

Bowel Distention
  • While we might not start neostigmine in the ED for this, it is good to know conservative management and bowel decompression are important to start as soon as the bowel distention is noted.[pedemmorsels.com]
Mediastinal Mass
  • Masses 1409 Pediatric 1419 Neonatal Bowel Obstruction 1421 Anomalies of Bowel Rotation Malrotation and Midgut Volvulus 1433 Abdominal Wall Defects Omphalocele and Gastroschisis 1439 Hypertrophic Pyloric Stenosis 1447 Intussusception 1455 Meckels Diverticulum[books.google.com]
Hyponatremia
  • (ex, hyponatremia) Conservative therapies are preferred: [ Shukla, 2007 ] Bowel rest Nasogastric decompression Rectal tube decompression (if distention extends to sigmoid region) Discontinue offending medications Medications: Neostigmine [Hooten, 2014[pedemmorsels.com]
Base Deficit
  • A viable female weighing 2510 g with Apgars of 7 and 8, and arterial cord pH of 7.28 with a base deficit of 3 was delivered. The patient then underwent a subtotal colectomy from the terminal ileum to distal sigmoid colon with ileostomy.[nature.com]
Staphylococcus Aureus
  • She was transfused with 3 pints of blood and placed on parenteral augmentin based on sensitivity of wound m/c/s result obtained which yielded mixed flora of E.Coli, pseudomonas aerugenosa, Staphylococcus Aureus, and metronidazole.[ghrnet.org]
Liver Biopsy
  • Biopsy Assessment in Liver Disease 604 Acute Hepatitis Management and Prevention 611 Chronic Hepatitis B 616 Chronic Hepatitis C 621 Viral Hepatitis in Children 625 Fulminant Hepatic Failure 629 Adult Liver Transplantation Selection and Pretransplant[books.google.com]

Treatment

  • The aim of the present review is to outline current perspectives in the pharmacological treatment of patients with acute colonic pseudo-obstruction.[ncbi.nlm.nih.gov]
  • Colonoscopic decompression may be required in patients failing to respond to conservative treatment. Neostigmine has been proposed as an effective treatment for ACPO as an alternative to colonoscopic decompression.[ncbi.nlm.nih.gov]
  • Neostigmine infusion should be administered with continuous cardiac monitoring for possible bradycardia, which may require treatment with atropine.[ncbi.nlm.nih.gov]
  • DATA SYNTHESIS: Neostigmine may provide an effective treatment option for postoperative acute colonic pseudo-obstruction (ACPO) after conservative treatment measures have failed.[ncbi.nlm.nih.gov]
  • Recently, the efficacy of pharmacologic treatment has been reported in adults, but no such data have yet been reported in children for treatment of acute colonic pseudo-obstruction resulting from chemotherapy.[ncbi.nlm.nih.gov]

Prognosis

  • As a result of this complication the prognosis worsens. Initially there are few clinical symptoms, but subsequently colonic obstruction develops which, if not treated, can cause perforation of the caecum resulting in a high mortality rate.[ncbi.nlm.nih.gov]
  • […] ischemia Treatment Treat any underlying medical conditions Rectal tube decompression Colonoscopic decompression Medications such as Neostigmine Rarely, surgical decompression such as cecostomy Complications Can lead to ischemic of bowel and perforation Prognosis[learningradiology.com]
  • Treatment and prognosis Treatment involves correction of the underlying disorder and correction of any biochemical abnormalities. Medical treatment options include anticholinesterases like neostigmine and antibiotics like erythromycin.[radiopaedia.org]
  • Prognosis Patients avoiding surgery and perforation make good recovery generally, although recurrence is common.[patient.info]
  • PROGNOSIS • It is a serious medical disorder and the mortality rate can be as high as 30%. • Drug induced mega colon has been associated with mortality as high as 27.5%11/21/2012 32 33.[slideshare.net]

Etiology

  • Upon diagnosis, initiating conservative management and identification of an underlying etiology is mandatory. We describe the case of an 8-year-old girl who presented with signs of acute abdominal distention with no evident etiology.[ncbi.nlm.nih.gov]
  • Its occurrence following extensive paraaortic dissection in this case but no report so far of its occurrence after routine radical hysterectomy supports the most commonly proposed etiology of disturbed splanchnic nerve supply to the colon as a cause.[ncbi.nlm.nih.gov]
  • Colonoscopy recently has proven to be highly effective in achieving colonic decompression as well as excluding a mechanical etiology for obstruction and poses minimal risk to the patient.[ncbi.nlm.nih.gov]
  • The damage to the neural ganglia in the intestinal wall is the most likely etiology. A 62-year man was admitted to the Emergency Department due to acute dyspnea and vomiting. The patient had not defecated for 10 days prior to admission.[ncbi.nlm.nih.gov]
  • Clinicians should be aware of this extrarenal K wasting etiology in patients with colonic pseudo-obstruction, particularly in those with CKD where such a severe K deficit is not anticipated and, therefore, may inhibit more rigorous K replacement.[ncbi.nlm.nih.gov]

Epidemiology

  • AIM: To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO).[ncbi.nlm.nih.gov]
  • Management of Chronic Peripheral Arterial Occlusive Disease 1811 Visceral Artery Occlusive Disease Mesenteric Occlusive Disease 1827 Acute Arterial Occlusions 1837 Venous and Lymphatic Disease 1847 Vascular Access for Hemodialysis 1861 The Diabetic Foot Epidemiology[books.google.com]
  • Typically, rapid-onset abdominal distension begins within a few days of the onset of the underlying illness. 2 Because ACPO is uncommon, one must look at reviews that examine several years of reported cases to be able to draw conclusions about the epidemiology[clinicalgate.com]
  • Epidemiology It is a rare condition and the incidence rate is not actually known. Males are more commonly affected than females. Oglivie's syndrome is more common in the elderly.[patient.info]
  • An epidemiologic survey of chronic intestinal pseudo-obstruction and evaluation of the newly proposed diagnostic criteria. Digestion. 2012. 86(1):12-9. [Medline]. Saunders MD. Acute colonic pseudo-obstruction.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • AIM: To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO).[ncbi.nlm.nih.gov]
  • Its aetiology and pathophysiology remains poorly understood and patients are still treated inappropriately. In this report, a patient with acute colonic pseudo-obstruction managed surgically is presented.[ncbi.nlm.nih.gov]
  • In this paper, we discuss the possible role of the colocolonic reflex in the pathophysiology of acute colonic pseudo-obstruction, and the delineation of true Ogilvie's syndrome from the other many causes of acute colonic pseudo-obstruction.[ncbi.nlm.nih.gov]
  • Acute colonic pseudo-obstruction is a life-threatening condition associated with several pathologic conditions, whose pathophysiology is still uncertain.[ncbi.nlm.nih.gov]
  • Its pathophysiology is still poorly understood. Since computed tomography (CT) often reveals a sharp transition or "cut-off" between dilated and non-dilated bowel, the possibility of organic colonic obstruction must be excluded.[ncbi.nlm.nih.gov]

Prevention

  • Early recognition of signs and symptoms of this condition and prompt accurate management are vital to prevent serious mortality.[ncbi.nlm.nih.gov]
  • Although acute colonic pseudo-obstruction is uncommon, it is important that obstetric practitioners recognize this clinical entity as the potentially fatal consequences of cecal perforation can be prevented by tube cecostomy.[ncbi.nlm.nih.gov]
  • Here, we examine how to differentiate mechanical bowel obstruction from adynamic ileus and look at how to prevent the occurrence of adynamic ileus while minimizing its severity and shortening its clinical course.[ncbi.nlm.nih.gov]
  • Colonoscopic decompression can achieve reversal of colonic dilatation in most cases, but in some patients prophylactic laparotomy is indicated for prevention of the catastrophic consequences of perforation.[ncbi.nlm.nih.gov]
  • Prevention of bacterial endocarditis. ‏[books.google.com]

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