Successful Treatment of Acute Colonic Pseudo-Obstruction in an Elderly Patient

Abstract

Acute colonic pseudo-obstruction is a syndrome characterized by massive dilation of the colon without mechanical obstruction. It develops in hospitalized patients with serious underlying medical and surgical conditions. We report on such a case that was successfully treated conservatively in our hospital. A 67-year-old man presented to the emergency room with gradual onset of abdominal distension and pain. According to his history, chronic diarrhea related to severe hypokalemia developed after he had received radical proctectomy because of rectal adenocarcinoma 1 year previously. During admission, extreme large-bowel dilatation (to 11cm, without obstruction) was shown on plain abdominal X-ray and computed tomography. Conservative treatment was given, including nothing by mouth, nasogastric and anal tube decompression, intravenous fluid hydration, nutrition supplementation, and antibiotics. Electrolytes, particularly for hypokalemia, were aggressively corrected. We did not perform neostigmine infusion, decompressive colonoscopy or surgery. The patient recovered smoothly and was discharged. We, therefore, report a case of acute colonic pseudo-obstruction that, through early detection by emergency department clinicians, had an excellent outcome following conservative management only.