Acute Colonic Pseudo-obstruction Research Articles

Efficacy and Safety of Neostigmine and Decompressive Colonoscopy for Acute Colonic Pseudo-Obstruction: A Single-Center Analysis.

BackgroundAcute colonic pseudo-obstruction (ACPO) is characterized by acute colonic dilation in the absence of anatomical obstruction. Neostigmine is an acetylcholinesterase inhibitor recommended as first-line salvage therapy for uncomplicated ACPO. Decompressive colonoscopy is recommended if neostigmine is contraindicated or unsuccessful. There is a need to better characterize relative efficacy and factors impacting treatment choice. The aim of the study was to examine the use, efficacy, and safety of neostigmine and decompressive colonoscopy in the management of ACPO at a single academic center.MethodsPatients ≥ 18 years of age meeting established criteria for uncomplicated ACPO and with cecal diameter ≥ 10 cm on imaging between 1999 and 2019 were identified. Individuals were categorized as having received supportive care alone or subsequent trials of neostigmine or decompressive colonoscopy. Demographics and pre- and post-intervention data were collected, including indication and contraindication to intervention used, time to intervention, initial response, and adverse events.ResultsIn 46 cases of ACPO (N = 42 patients), all but one individual received initial supportive care. Seven responded to conservative measures alone. Of the patients failing supportive care, 15 cases were initially treated with neostigmine (response rate 86.7%) and 24 initially underwent decompressive colonoscopy (response rate 95.8%) (P = 0.390). One episode of transient bradycardia, resolved with atropine, occurred in the neostigmine group. One patient experienced respiratory instability during colonoscopy.ConclusionsBoth neostigmine and decompressive colonoscopy appear effective for treating uncomplicated ACPO in individuals failing conservative therapy. Adverse events were infrequent in both cohorts. Future prospective studies examining treatment for ACPO should focus on whether either intervention is superior to the other.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction.

A CASES OF ACUTE COLONIC PSEUDO-OBSTRUCTION LEADING TO CECAL PERFORATION POST LSCS CASE.

Acute colonic pseudo-obstruction is rare but not very un-common to nd post LSCS, if diagnosed late can cause severe maternal morbidity and mortality. Surgical intervention is must if diagnosed late, and is associated with long term morbidity to the patient. In this case, signs of bowel perforation were noted and laparotomy performed, ndings suggestive of cecal perforation were seen. Although uncommon after a Caesarean section but diagnosis of Ogilvie’s syndrome should be kept in mind.

Acute colonic pseudo-obstruction and rapid septic progression after transabdominal preperitoneal hernia repair: a case report

BackgroundAcute colonic pseudo-obstruction (ACPO) is a rare condition observed in patients with some underlying medical or surgical conditions. To the best of our knowledge, this is the first case report of a patient with ACPO development and rapid septic progression after laparoscopic inguinal hernia repair.Case presentationA 78-year-old man who underwent transabdominal preperitoneal hernia repair (TAPP) for right inguinal hernia presented with difficulty in defecation and abdominal distension. He visited our emergency department on the third postoperative day. Enhanced computed tomography (CT) detected marked enlargement from the cecum to the rectum. There was no evidence of mechanical obstruction, ischemia, or perforation. He was diagnosed with postoperative constipation and received conservative management. He gradually started to improve; however, he suddenly experienced cardiopulmonary arrest 30 h after admission and could not be resuscitated. CT imaging of the abdomen during autopsy did not show any significant change, such as perforation, from the time of admission. Based on the clinical course and examination results, postoperative ACPO was considered the fundamental cause of fulminant obstructive colitis leading to sepsis.ConclusionsACPO following minimally invasive surgery is exceedingly rare. However, it is important to consider this disease as one of the differential diagnoses to avoid missing the chance for advanced therapy.

529 Acute Colonic Pseudo-Obstruction: A Critical Complication in Burn Patients

Abstract Introduction Acute Colonic Pseudo-Obstruction (ACPO) is a rare clinical condition characterized by gross dilation of the large bowel in the absence of an obstruction. It presents a particularly complex challenge in diagnosis and management in the context of burn trauma. We followed five burn patients who developed ACPO that did not respond to conservative treatments. These patients ultimately required surgical intervention to resolve their ACPO. Through our study, we propose that traditional management may not be successful in fully treating ACPO in burn patients without recurrence and that complete resolution necessitates a more aggressive management course, often in the form of surgical intervention. Methods We studied the clinical course of all burn patients who developed ACPO in the past 2 years at our burn center. Using Electronic Health Records, we collected patient demographic data, percent total burn surface area (%TBSA), hospital length of stay, cecal diameter, bowel regimen for catharsis, and vital sign measurements. Abdominal CT scans and X-rays were used to monitor the progression of cecal diameter. Results We have noted that burn patients who are at a high risk of developing ACPO tend to either be obese, have large TBSA burns (>20%), or have a combination of both. Furthermore, patients who had a greater percentage of 3rd degree burns had worse outcomes. All patients received acetylcholinesterase inhibitors (AChEi’s), but ultimately underwent some manner of further intervention for complete resolution of ACPO. Two patients were treated solely with decompression: one via NGT suction, the other via colonoscope. Three patients received surgical intervention through hemicolectomy, subtotal colectomy, and cecostomy. The former two subsequently expired, one due to direct ACPO complications; the latter three survived and remain well today. Conclusions ACPO is a rare but serious complication in burn patients that may easily be missed by the diagnosing clinician. In the treatment of ACPO in burn patients, one should consider a more aggressive approach, as traditional medical therapy may not be enough to resolve the original distention or prevent a recurrence. In our review of five burn patients that subsequently developed ACPO, surgical intervention was universally the mechanism by which definitive resolution of the condition was achieved.

Acute colonic pseudo-obstruction in two patients admitted with severe acute respiratory syndrome-coronavirus-2 pneumonia.

We have described two cases of severe SARS-CoV-2 pneumonia presenting with acute colonic pseudo-obstruction with normal liver enzymes and serum lactate. These older adults presented predominantly with constitutional symptoms, silent hypoxia, distended abdomen, sluggish bowel sounds, and colonic dilatation supported by abdominal imaging (plain X-ray and computerized tomography of abdomen) to a tertiary care center in South India. Both patients received standard treatment for severe SARS-CoV-2 pneumonia and acute colonic pseudo-obstruction according to available guidelines but succumbed to complications during hospital stay. Acute colonic pseudo-obstruction in patients admitted with SARS-CoV-2 infection requires high index of suspicion as it warrants early mitigation by cessation of offending agents, optimizing electrolytes, and colonic decompression to prevent morbidity and mortality.

Neostigmine for Treating Acute Colonic Pseudo-Obstruction in Neurocritically Ill Patients.

Background and PurposeAcute colonic pseudo-obstruction (ACPO) is a common but understudied complication in neurocritically ill patients. The acetylcholinesterase inhibitor neostigmine can be used to treat ACPO in patients who do not respond to conventional treatment. This study investigated the effectiveness and adverse events when using neostigmine to manage ACPO in neurocritically ill patients.MethodsThis retrospective study investigated patients with ACPO who were treated using neostigmine in the neurological intensive-care units at two centers between March 2017 and August 2020. Neostigmine was administered intravenously or subcutaneously (at doses ranging from 0.25 mg to 2 mg) according to the protocols at the two centers. The outcomes were bowel movements and the changes in colon diameters on abdominal radiographs. Safety events such as bradycardia, vomiting, salivation, and sweating were evaluated.ResultsThis study included 31 subjects with a mean age of 46.8 years (65.4% males). All patients had a bowel movement at a median of 120 minutes after administering neostigmine. The colon diameter decreased by a median of 17.5 mm (paired t-test: p<0.001) regardless of the dose and treatment protocols. Multilevel analysis confirmed that the mean colon diameter decreased from 66 mm pretreatment to 47.5 mm posttreatment (p<0.001), with an intraclass correlation coefficient of 13%. Three patients (9.7%) exhibited hypersalivation, sweating, bradycardia, and vomiting. Bradycardia (heart rate, 42 beats/minute) occurred in one patient (3.2%), and was successfully managed by injecting atropine.ConclusionsNeostigmine injection is a safe and effective treatment option for ACPO in neurocritically ill patients who fail to respond to conservative management.

Acute colonic pseudo-obstruction with COVID-19.

Acute colonic pseudo-obstruction with COVID-19.

Acute colonic pseudo-obstruction in a patient following total abdominal hysterectomy and bilateral salpingo-oophorectomy (Ogilvie syndrome)

A 50-year-old woman underwent total abdominal hysterectomy and bilateral salphingo-oophorectomy for heavy menstrual bleeding due to a uterine fibroid. On second post-operative day she developed progressive abdominal distention, tachycardia, and fever. An intra-abdominal pathology was suspected and she was re-opened on the third postoperativeday. At laparotomy a distended colon was found with serosal tears due to distention with no distal colonic obstruction. Bowel decompression was done and a diagnosis of acute colonic pseudo-obstruction (ACPO) was made. Since her abdominal distention was persisting after the laparotomy she was treated with intravenous neostigmine. She responded immediately with passage of flatus and bowel opening. Subsequent recovery was uneventful. ACPO is a clinical entity characterized by severe colonic distention in the absence of mechanical obstruction. It can result in bowel ischaemia and perforation if left untreated. Therapeutic importance of neostigmine is discussed in the management ofthis potentially fatal condition.

Neostigmine for the treatment of acute colonic pseudo-obstruction

Neostigmine for the treatment of acute colonic pseudo-obstruction

Left Ventricular Compression and Hypotension Due to Acute Colonic Pseudo-Obstruction.

Acute colonic pseudo-obstruction is a postsurgical dilatation of the colon that presents with abdominal distension, pain, nausea, vomiting, constipation, or diarrhea and may lead to colonic ischemia and bowel perforation.

Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report

BackgroundOgilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications.Case presentationA 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later.ConclusionOgilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status.

S1828 Non-Operative Management of Acute Colonic Pseudo-Obstruction With Ischemia

S1828 Non-Operative Management of Acute Colonic Pseudo-Obstruction With Ischemia

S1694 Colonic Ileus: A Rare Complication of Positive Pressure Ventilation

INTRODUCTION: Gastric insufflation may be seen in up to 30% of patients receiving non-invasive positive-pressure ventilation (PPV). However, it rarely causes significant observable effects given the integrity of the lower esophageal sphincter, which prevents large amounts of air from entering the gastric lumen. Here we report a rare complication of PPV. CASE DESCRIPTION/METHODS: A 68-year-old male with chronic obstructive pulmonary disorder and chronic kidney disease presented with one week of severe dyspnea, wheezing, and productive cough. The patient received intravenous ceftriaxone, azithromycin, and nebulized albuterol in the ED. Within hours, the patient oxygen saturation decreased to 60% and he became unarousable. The patient underwent tracheal intubation and was extubated the following day. The patient required BIPAP support for the next 4 days. On day 6 of hospitalization, the patient developed severe nausea and diffuse abdominal pain. Clinical examination was significant for firm abdominal distension, diffuse abdominal tenderness without rebound or guarding, and hyperresonance on percussion. Abdominal X-ray revealed a markedly dilated large bowel, concerning for large bowel obstruction versus ileus that was not present on admission (image 1). Subsequent CT imaging of the abdomen and pelvis revealed no free air, but diffuse distension of the proximal, transverse, and sigmoid colon, with the largest segment measuring 10.5 cm, consistent with large bowel ileus (image 2). After receiving multiple enemas and 2 liters of polyethylene glycol/electrolyte solution, the patient passed a significant amount of stool with complete resolution of his abdominal pain and distension. DISCUSSION: Gastrointestinal complications of PPV include stress ulcers, impaired gastric emptying, diarrhea, constipation, obstruction, and rarely, colonic perforation. Those with acute respiratory failure with superimposed COPD are at greater risk for developing ileus due to an increased risk of exaggerated aerophagia. PPV is associated with elevated catecholamines and increased sympathetic activity, which results in splanchnic hypoperfusion. This causes an oxygen supply and demand imbalance in the GI tract, resulting in mucosal damage and alterations in GI motility. In this case, acute colonic pseudo-obstruction developed after 6 days of PPV. It highlights the importance of careful assessment in patients at risk for exaggerated aerophagia due to the risk of colonic ileus and possible perforation.Figure 1.: Left: Chest X-ray on admission showing hyperinflated lungs without colonic dilation. Right: Abdominal X-ray hospital day 6 with colonic dilation.Figure 2.: CT abdomen and pelvis showing diffuse colonic dilation without perforation.

Síndrome de Ogilvie asociado a hospitalización prolongada en un paciente con evento vascular cerebral isquémico. Reporte de un caso

Introduction: Ogilvie’s syndrome or acute colonic pseudo-obstruction is the acute dilation of the colon without evidence of mechanical obstruction and is attributed to an autonomic imbalance of motor innervation of the colon. It is common in hospitalized patients with significant comorbidities. Its management is staggered, reserving surgical management for cases refractory to initial medical management or with the presence of complications such as perforation and sepsis data. Case report: We present the case of a 69-year-old male patient who went to the emergency service in the context of a cerebral vascular event. He underwent prolonged intubation, which began 17 days after his admission with abdominal distention refractory to medical management, with significant colonic dilation corroborated by abdominal tomography, so it was decided to manage it surgically. Conclusions: It is important to make an early diagnosis of this syndrome to avoid complications of the disease, as well as surgery. It is important to make a differential diagnosis with other causes of occlusion and have a high index of suspicion since it is a diagnosis of exclusion. Keywords: Colonic pseudo-obstruction; colectomy; cerebral stroke; megacolon

Acute colonic pseudo-obstruction after cesarean section and gastrointestinal symptoms⋆

ObjectiveTo investigate whether women who developed acute colonic pseudo-obstruction (ACPO) after cesarean section have a higher degree of gastro-intestinal symptoms than women who did not develop ACPO after cesarean section. ACPO is a colonic dilatation without mechanical obstruction, and with an unknown pathophysiology. In younger people it is mostly seen in women after cesarean section. The hypothesis of the present study is that long-term consequences of gastrointestinal symptoms evolve after ACPO, due to the impact on the colon. Study design40 women who developed ACPO after cesarean section (cases) and 80 women, who did not develop ACPO after cesarean section (controls), were asked to participate in the study. The controls were matched based on time of cesarean section (± 14 days), age (±5 years), singleton or twin, parity, cesarean section grade, and ASA-group. Baseline characteristics and information regarding the cesarean section were collected from medical records. An electronic collection of surveys was distributed to the participants, including the following: Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS), Rome IV, Gastrointestinal Symptoms Rating Scale (GSRS), Visceral Sensitivity Index (VSI), Patient Health Questionnaire 15 (PHQ15), The MOS 36-item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The score from IBS-SSS after cesarean section was used as the primary outcome. Results25 cases and 37 controls participated in the study. A difference in blood loss was found with a median of 600 mL in cases, compared to 400 mL in controls during cesarean section (p = 0.002). No difference was found between cases and controls in the IBS-SSS score after cesarean section. However, cases yielded a higher difference between IBS-SSS before and after cesarean section, indicating a higher degree of deterioration in gastrointestinal symptoms (p = 0.026). In addition, cases reported a higher degree of pain in everyday life (p = 0.039). No difference was found in the remaining surveys. ConclusionWomen undergoing cesarean section developed mild grade of irritable bowel syndrome. However, gastrointestinal symptoms did not seem to be more prevalent in women who developed ACPO, although women with ACPO had a higher degree of deterioration in gastrointestinal symptoms than controls.

Case Report of Ogilvie's Syndrome Following Emergency Haemostatic Subtotal Abdominal Hysterectomy at University Teaching Hospital of Butare, Rwanda.

Background:Acute colonic pseudo-obstruction or Ogilvie's syndrome is a rare condition that usually develops due to a dysregulated autonomic nervous system following a medical or surgical condition. With delayed diagnosis, it may lead to bowel ischemia and perforation with poor prognosis.Case:We report a case of a 33 years old female, Gravida 1, Para1, who developed severe abdominal distension following abdominal haemostatic hysterectomy due to a severe postpartum haemorrhage and shock requiring epinephrine infusion after a spontaneous vaginal delivery. The postpartum haemorrhage was due to both atony and posterior cervical tear. Two initial administrations of neostigmine 2 mg mixed with atropine 0.5 mg were unsuccessful, but an insertion of a flexible recto-sigmoid cannula allowed a slight decompression. A subsequent third dose of neostigmine 2 mg mixed with atropine 0.5 mg was followed with a remarkable flatus evacuation and complete decompression.Conclusion:Prompt diagnosis and management of Ogilvie's syndrome is crucial in order to avoid subsequent complications. In case of postoperative cecal and colonic distension without mechanical obstruction, Ogilvie's syndrome should be suspected as this will ensure timely and adequate management of patients at risk including obstetric patients.

Triple Trouble: Colonic Obstruction by Sigmoid Volvulus in a Patient Affected by Ogilvie Syndrome and Giant Bochdalek Hernia

Bochdalek hernia is a congenital left diaphragmatic hernia (CDH), usually diagnosed in children following the onset of thoracic symptoms such as dyspnea or tachycardia. Ogilvie’s syndrome (or acute colonic pseudo-obstruction) may be due to several conditions, including neurologic diseases, neuroleptic therapy and systemic syndromes, and is characterized by massive colon dilation in the absence of mechanical obstruction or toxic mega-colon. Sigmoid volvulus, consisting of sigmoid rotation around its axis, is a relatively frequent cause of large bowel obstruction. The three simultaneous conditions in the same patient in an emergency setting are rare, leading to a challenging situation concerning diagnosis and management. Here, we report the case of a mentally disabled 59-year-old female presenting with colonic obstruction caused by sigmoid volvulus after several episodes of Ogilvie’s syndrome-related pseudo-occlusion, found to have a giant left-sided Bochdalek diaphragmatic hernia. The patient was treated by an emergency laparoscopic approach. Despite the resolution of the abdominal picture, the patient died on postoperative day 15 by respiratory failure.

Incidence and Risk Factors for the Development of Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) in Total Joint Arthroplasty Patients.

Acute colonic pseudo-obstruction (Ogilvie syndrome [OS]) is a rare but devastating condition that can develop in orthopaedic patients postoperatively. The objective of this study was to identify the risk factors for developing OS after total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to compare the outcomes between patients who did and did not develop OS postoperatively. This was a retrospective review using the National Inpatient Sample, a national database incorporating inpatient hospitalization information. ICD-9 codes were used to identify patients who underwent primary and revision THA or TKA. Patients were separated based on the diagnosis of OS. Primary outcomes assessed included patient mortality, postoperative complications, length of stay, and cost during index hospitalization. From 2001 to 2014, a total of 12,541,169 patients underwent primary and revision THA or TKA. Of those, 3,182 patients (0.03%) developed OS postoperatively. There was an increased incidence of OS in revision THA and TKA compared with primary THA and TKA. Fluid and electrolyte disorders were associated with the largest increased adjusted risk of OS. Patients with OS had an increased adjusted risk of overall postoperative complications and being discharged to skilled nursing facility. Patients with OS had an increased average length of stay and hospitalization cost compared with patients without OS. Given our findings, the risk factors for the development of OS, including revision surgery, should be identified and minimized during the perioperative period to prevent the development of this morbid and potentially life-threatening complication. III (Retrospective cohort study).

Heparin-induced thrombocytopenia and acute colonic pseudo-obstruction after therapeutic anticoagulation in a very elderly patient with hip fracture: a case report

BackgroundHip fractures have become a severe public health problem, especially in very elderly patients. Most of them are treated with low molecular weight heparin as prophylaxis or treatment of venous thromboembolism. Heparin-induced thrombocytopenia is one of the complications induced by low molecular weight heparin, which may cause poor prognosis. However, there is not enough awareness for heparin-induced thrombocytopenia in very elderly trauma patients.Case presentationWe report a case of hip fracture with heparin-induced thrombocytopenia in a very elderly patient. The patient developed heparin-induced thrombocytopenia, digestive hemorrhage and acute colonic pseudo-obstruction after the use of low molecular weight heparin, which eventually led to death.ConclusionsThis is the first case report of digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients with major trauma. This case highlights the severity of HIT in very elderly patients with hip fractures using low molecular weight heparin, and the need for platelet monitoring in these patients. We indicate that there may be a correlation of pathogenesis between digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients.