GASTROENTEROLOGY ARTICLE OF THE WEEK
February 13, 2002
ASGE. Acute colonic pseudo-obstruction. Gastrointest Endosc 2002;56:789-809.
1. Initial approach to acute colonic pseudo-obstruction (ACPO) should include
a. control of emesis with phenothiazines
b. testing for electrolyte and metabolic abnormalities
c. nasogastric decompression
d. immediate colonoscopy
2. ACPO
a. usually occurs in the setting of colonic obstruction
b. spontaneous perforation occurs in 3% to 15% of cases
c. Cecal diameter >10-12cm is associated with increased risk of perforation
d. Perforation is more likely if the distention lasts > 6 days.
3. Treatment with neostigmine
a. can trigger bradycardia, asystole, hypotension, restlessness and seizures
b. atropine is the antidote
c. contraindicated in patients with urinary obstruction
True or False
4. If there is a question as to whether there is colonic obstruction or not, a barium enema should be performed.
5. Colonoscopy decompression carries a perforation risk of approximately 3%.
6. Prone position with hips elevated on a pillo or the knee-chest position with hips held high often aids in spontaneous evacuation of flatus
7. In adequate candidates, a trial of neostigmine should be performed prior to colonoscopic decompression.
8. Conservative measures should be continued for 3 to 6 days