After major trauma or uncomplicated surgery, particularly abdominal, pelvic or hip[1], bowel usually takes a couple of days to function again (paralytic ileus). Uncommonly, not only is recovery delayed but there is progressive distension of the colon (large bowel) even though there is no mechanical obstruction.
The diagnosis depends on measurement of the diameter of the colon on serial radiographs, which should be part of the postoperative routine if paralytic ileus is prolonged.
| PRACTICE
POINT Look for serial plain abdominal radiographs if paralytic ileus prolonged beyond 2-3 days |
Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) may greatly increase acuity of illness[2], compromise the blood-supply to the bowel[1], and rarely progress to intestinal perforation, if unrelieved.
Relief of the distension, and prevention of perforation, may be achieved by passage of a flatus tube. Failing this, colonoscopy tube placement is routine and generally effective[2], [3].
| PRACTICE
POINT Free fluid and gas in the abdomen indicates acute, not earlier, bowel perforation |
When timely diagnosis has not been made, there maybe medicolegal, or even medical, confusion about the origin of the perforation. If inadvertent bowel injury occurred during the original surgery, there would be signs of infection and abscess formation, not the free gas and fluid in the abdominal or pelvic cavities seen after acute perforation.
Copyright © 2008 Electronic Handbook of Legal Medicine