Article References: Pseudo Obstructions

PSEUDO-OBSTRUCTION

1.AUTHOR	Ballaro-A, Gibbons-C-L, Murray-D-M, Kettlewell-M-G, Benson-M-K.
INSTITUTION	Nuffield Orthopaedic Centre, Oxford, England.
TITLE	Acute colonic pseudo-obstruction after total hip replacement.
SOURCE	J-Bone-Joint-Surg-Br 1997 Jul, VOL: 79 (4), P: 621-3, ISSN: 0301-620X.
Abstract	Acute colonic pseudo-obstruction is a poorly recognised and potentially fatal complication of hip surgery. Between 1991 and 1994 six patients were observed who required laparotomy after failure of medical management. In three the indication was signs of peritonism, while in the other three exploration was required to exclude segmental ischaemia and to decompress the bowel. In all, there was no evidence of mechanical obstruction. Patients having total hip replacement are at risk of developing pseudo-obstruction due to their age, comorbidity, high doses of analgesics and the nature of the operation. If postoperative ileus persists for more than 48 hours acute colonic pseudo-obstruction should be suspected and confirmed by plain radiography. Prompt recognition and treatment with early referral to a colorectal unit are indicated. Laparotomy appears to carry less risk than that for patients with idiopathic pseudo- obstruction, but should be performed only if colonic ischaemia is suspected. Author.

2 .AUTHOR	Geller-A, Petersen-B-T, Gostout-C-J.
INSTITUTION	Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
TITLE	Endoscopic decompression for acute colonic pseudo-obstruction.
SOURCE	Gastrointest-Endosc 1996 Aug, VOL: 44 (2), P: 144-50, ISSN: 0016-5107.
Abstract	BACKGROUND: Acute colonic pseudo-obstruction is often treated by colonoscopic decompression. Efficacy, safety, and outcome of endoscopic decompression was assessed. METHODS: Colonoscopic decompressions from 1988 to 1994 were reviewed. Resolution without further endoscopic intervention was defined as clinical success. RESULTS: Acute colonic pseudo-obstruction was diagnosed in 50 patients. Thirty-three cases followed surgery or trauma and 17 developed during severe medical illness. Orthopedic joint surgery was most common. Nineteen of 50 patients (38%) had severe underlying medical disease. Forty-one patients (82%) had one colonoscopic decompression with clinical success in 39 (95%). Nine patients (18%) required multiple (2 to 4) colonoscopic decompressions with clinical success in 5 (56%). A decompression tube positioned in the right colon (57%) and in the transverse colon (33%) had similar clinical success. In 8 procedures a decompression tube was not placed, with poor clinical success (25%). The overall clinical success of colonoscopic decompression was 88% (44 of 50). An endoscopic perforation occurred in 1 patient (2%). Overall hospital mortality was 30%. CONCLUSIONS: Colonoscopic decompression is effective and safe for acute colonic pseudo-obstruction that does not respond to conservative therapy. Most patients will respond to one colonoscopic decompression with decompression tube placement. Complete colonoscopy and cecal tube placement is unnecessary. Author.

3 .AUTHOR	Rex-D-K.
INSTITUTION	Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University Hospital and Outpatient Center, Indianapolis, Indiana 46202-5000, USA.
TITLE	Colonoscopy and acute colonic pseudo-obstruction.
SOURCE	Gastrointest-Endosc-Clin-N-Am 1997 Jul, VOL: 7 (3), P: 499-508, ISSN: 1052-5157 69 Refs.
Abstract	There is no well-defined standard of care for the use of colonoscopy in the treatment of acute colonic pseudo-obstruction (ACPO). Colonoscopy can be helpful for ACPO, but it can be accompanied by complications, is not completely effective, and can be followed by recurrence. These possibilities must be weighed against the overall risk of spontaneous perforation, which is low but real. The use of colonoscopy therefore should be selective, and it should be performed by experts and accompanied generally by tube placement. Author.