Acute Colonic Pseudo-Obstruction

Acute colonic pseudo-obstruction is a pathologic dilatation of the colon without the presence of mechanical obstruction or inflammatory process in the colonic wall. The pathogenic factors for this disorder include autonomic imbalance, degeneration of enteric ganglion cells, elevated nitric oxide, activation of colo-colonic inhibitory reflex, and disruption of enteric nervous system and its neurotransmitters by various chronic diseases, medications, and infections. Acute colonic pseudo-obstruction usually occurs in older adults who have multimorbidity or use medications affecting the bowel motility. Abdominal distention and pain are the main features of this condition. X-ray or computed tomography scan of the abdomen help in establishing the diagnosis. Timely recognition and close monitoring are important in management. Nonoperative management, including neostigmine injection and colonoscopic decompression, should be started immediately in uncomplicated cases. Surgical intervention is mainly indicated in the presence of ischemia, perforation, or refractoriness to nonoperative measures.