Abstract
Objective. To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening. Methods. ACPO patients with feeding tolerance were divided into ACPO with no obvious gut wall thickening (ACPO-NT) group and ACPO with obvious acute gut wall thickening (ACPO-T) group according to computed tomography and abdominal radiographs. Patients' condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared. Results. Patients in ACPO-T group had a significantly higher APACHE II (11.82 versus 8.25, p = 0.008) and SOFA scores (6.47 versus 3.54, p < 0.001) and a significantly higher 28-day mortality (17.78% versus 4.16%, p = 0.032) and longer intensive care unit stage (4 versus 16 d, p < 0.001). Patients in ACPO-NT group were more likely to be responsive to supportive treatment (62.50% versus 24.44%, p < 0.001), neostigmine (77.78% versus 17.64%, p < 0.001), and colonoscopic decompression (75% versus 42.86%, p = 0.318) than those in ACPO-T group. Of the patients who underwent ileostomy, 81.25% gained benefits. Conclusions. ACPO patients with gut wall thickening are more severe and are less likely to be responsive to nonsurgical treatment. Ileostomy may be a good option for ACPO patients with gut wall thickening who are irresponsive to nonsurgical treatment.
Highlights
Feeding intolerance (FI) is a common and clinically important problem in critically ill patients
FI manifested as gastrointestinal symptoms such as abdominal distension, diarrhea, vomiting, and gastric retention, and inadequate enteral calorie intake is the biggest challenge in maintaining enteral nutrition (EN) in critically ill patients, which could cause or exacerbate malnutrition and has been associated with longer intensive care unit (ICU) stay and higher morbidity and mortality [1, 2]
396 patients remained due to the diagnosis of acute colonic pseudo-obstruction (ACPO)
Summary
To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening. Patients’ condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared. Patients in ACPO-NT group were more likely to be responsive to supportive treatment (62.50% versus 24.44%, p < 0 001), neostigmine (77.78% versus 17.64%, p < 0 001), and colonoscopic decompression (75% versus 42.86%, p = 0 318) than those in ACPO-T group. Of the patients who underwent ileostomy, 81.25% gained benefits. ACPO patients with gut wall thickening are more severe and are less likely to be responsive to nonsurgical treatment. Ileostomy may be a good option for ACPO patients with gut wall thickening who are irresponsive to nonsurgical treatment
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