Clinical profile of patients and various modes of management in acute colonic pseudo obstruction

Abstract

Aims & Objectives: To see the various modes of management in patients who diagnosed with Acute Colonic Pseudo obstruction (ACPO). The primary objective is to find out the clinical profile of patients of ACPO. Material and Methods: This was an observational study which would require conservative mode Ryle’s tube, flatus tube, electrolyte correction, colonoscopy. Intervention option like decompression tube or surgical management as per treatment algorithm, All the information required as per study proforma was collected over the first encounter. Follow up is not required. No additional cost burden on patient for this study. Results: A total 23 patients were enrolled for study. Various modes according to the algorithm had been tried for management of ACPO. All patient had undergone X Ray Abdomen and/or CT scan. 4 out of 23 patients (17.4%) were on conservative measures, out of 2 patients were resolved and 2 died. Conservative measures included Nil by mouth, nasogastric decompression, rehydration, electrolyte correction and passage of flatus tube per rectum for 48 hours. One patient had been tried pharmacological therapy by injecting neostigmine but remained unsuccessful, rest had contraindications to pharmacological therapy. The other 19 patients failed to respond with conservative measures and thus they underwent interventional procedure (colonoscopy) which had not revealed any mechanical cause. Out of 19 patients,15 patients were benefited by placement of colonic decompression tube for 3 days. One patient treated with tube caecostomy. One patient had ceacal perforation for which Colectomy and ileostomy was done. Conclusions: ACPO occurs in heterogenous group of patients, the exact aetiology and pathogenesis is not known. There should be high level of clinical suspicion. Once the diagnosis of ACPO has stablished and initial conservative management is unsuccessful, further measures are to be taken as per decisional algorithm. Colonoscopy and insertion of decompression tube leads the list of interventional procedure. In view of its high associated mortality, surgical intervention should only be a last recourse after failure of endoscopic procedures or when colonic perforation makes surgery unavoidable.

Keywords

• acpo (acute colonic pseudo-obstruction)
• colonic decompression
• tube caecostomy