Acute Colonic Pseudoobstruction Syndrome is a group of syndromes characterized by primary or secondary colonic dilation without intrinsic colonic pathology. It commonly occurs in chronically ill and long-term bedridden patients, with the affected areas typically being the ileocecal region or the right colon.

bubble_chart Etiology

Secondary colonic pseudo-obstruction often occurs in diseases such as scleroderma, amyloidosis, myotonic dystrophy, hypothyroidism, Chagas disease, and central nervous system dysfunction. It can also be drug-induced or occur postoperatively, during pregnancy, after artificial late abortion, following vascular reconstruction, due to alcoholism, trauma, cancer, and sepsis.

bubble_chart Clinical Manifestations

The main manifestation is rapidly progressive abdominal distension and fullness, but in cases of slow progression, there may be no abdominal symptoms, with nausea and vomiting absent.

bubble_chart Diagnosis

The best diagnostic method is a plain abdominal X-ray, which may show segmental dilation of the colon, with significant dilation of the ileocecal region and ascending colon. Some patients may also exhibit gas in the descending colon and rectum. Nasogastric tube aspiration can aid in differentiation. If the plain abdominal X-ray is inconclusive, a barium enema can be used to establish the diagnosis after ruling out the presence of perforation.

bubble_chart Treatment Measures

During treatment, gastrointestinal decompression should be prioritized. If there is no improvement after 12 hours, surgical gastrointestinal decompression should be performed. If colonic necrosis is present, resection may be considered. Alternatively, decompression under colonoscopy can also be attempted.

It should be differentiated from ileocecal volvulus, sigmoid colon volvulus, acute gastric dilatation, and gastric pseudo-obstruction.