New solutions to an old problem: acute colonic pseudo-obstruction.

Acute colonic pseudo-obstruction remains a serious medical disorder, carrying a mortality rate of 15%. It occurs in the setting of a wide variety of medical and surgical illnesses. The suspected pathogenesis consists of an autonomic imbalance resulting from decreased parasympathetic tone or excessive sympathetic output. Patients typically present with abdominal distension, pain, and altered bowel movements. Progression of disease can lead to colonic ischemia and perforation. The diagnostic evaluation excludes mechanical obstruction, toxic megacolon, perforation, and ischemia. Initial treatment most often consists of conservative measures that are followed by intravenous neostigmine when the patient fails to improve. When colonic distension persists, decompression colonoscopy is preformed. Occasionally, these measures fail necessitating surgical intervention.