Systematic review: acute colonic pseudo‐obstruction

Abstract

Summary Acute colonic pseudo‐obstruction is the clinical syndrome of acute large bowel dilatation without mechanical obstruction that is an important cause of morbidity and mortality. Acute colonic pseudo‐obstruction occurs in hospitalized or institutionalized patients with serious underlying medical and surgical conditions. The pathogenesis of acute colonic pseudo‐obstruction is not completely understood but likely results from an imbalance in the autonomic regulation of colonic motor function. Metabolic or pharmacological factors, as well as spinal or retroperitoneal trauma, may alter the autonomic regulation of colonic function, leading to excessive parasympathetic suppression or sympathetic stimulation. This imbalance results in colonic atony and dilatation. Early recognition and appropriate management are critical to minimizing morbidity and mortality. The mortality rate is estimated at 40% when ischaemia or perforation occurs. The best‐studied treatment of acute colonic pseudo‐obstruction is intravenous neostigmine, which leads to prompt colon decompression in the majority of patients after a single infusion. In patients failing or having contraindications to neostigmine, colonoscopic decompression is the active intervention of choice. Surgery is reserved for those with peritonitis or perforation.

Constipação intestinal em terapia intensiva

“…(29) Its incidence is not well established in literature. It is an important cause of morbidity and mortality in ICU patients, (30)(31) and in presence of intestinal perforation, mortality can exceed 50%. (31) It is caused by imbalance of the autonomic activity with parasympathetic suppression and increased sympathetic activity.…”

“…It is an important cause of morbidity and mortality in ICU patients, (30)(31) and in presence of intestinal perforation, mortality can exceed 50%. (31) It is caused by imbalance of the autonomic activity with parasympathetic suppression and increased sympathetic activity. Interruption of the autonomic nerves activity, from S2 to S4 leaves the distal colon sluggish and the proximal colon functioning.…”

“…Interruption of the autonomic nerves activity, from S2 to S4 leaves the distal colon sluggish and the proximal colon functioning. (30)(31)(32) This may be caused by electrolyte disturbances, mostly hypocalemia, hypocalcemia and hypomagnesemia. The clinical condition may be represented by: abdominal distention (100%), abdominal pain (80%) and nausea/ vomiting (60%).…”

“…(30,33) Distension develops for 3 to 7 days, but can occur in less than 24 hours. (31) The differential diagnosis includes mechanical obstruction and megacolon due to Clostridium difficile. (31) Colonic distension should be confirmed by simple abdominal X-ray and mechanical obstruction should be discarded by computed tomography (Figures 1 and 2).…”

“…(31) The differential diagnosis includes mechanical obstruction and megacolon due to Clostridium difficile. (31) Colonic distension should be confirmed by simple abdominal X-ray and mechanical obstruction should be discarded by computed tomography (Figures 1 and 2). The treatment assesses signs of impending or already installed perforation.…”