Endoscopic Management of Acute Colonic Obstruction and Pseudo-obstruction

  • Thomas C. Queen
  • Douglas G. AdlerEmail author


In acute colonic pseudo-obstruction (ACPO), supportive management and medical treatment with neostigmine are initial mainstays of therapy. Colonoscopic decompression with tube placement provides reliable relief in patients who do not respond to medical therapy or have contraindications to the use of neostigmine. Advanced techniques, such as percutaneous endoscopic cecostomy or colostomy, are alternatives to tube decompression, although additional studies are needed to assess their safety and efficacy. Self-expanding metal stent placement for acute colonic obstruction (ACO) due to malignancy is indicated in a palliative setting or as a preoperative bridge until definitive surgery is feasible. Decompression tube placement and tumor debulking with endoscopic laser treatment are no longer first-line therapy for malignant ACO. Recent advances in endoscopic management of ACPO and MCO have reduced the need for emergent surgery, with high technical and clinical success rates and improved patient outcomes.

This chapter includes supplementary videos.


Ogilvie’s syndrome Acute colonic pseudo-obstruction Colonic obstruction Colonoscopy Colonic stent Stents 

Supplementary material

Video 17.1

Self-expanding metal stent placement for acute colonic obstruction due to partially obstructing tumor (MP4 25364 kb)

Video 17.2

Self-expanding metal stent placement for acute colonic obstruction due to near-completely occluding tumor (MP4 69836 kb)

Video 17.3

Endoscopic management of sigmoid volvulus (MP4 30813 kb)


  1. 1.
    Villar HV, Norton LW. Massive cecal dilation: pseudoobstruction versus cecal volvulus? Am J Surg. 1979;137:170–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Eisen GM, Baron TH, Dominitz JA, et al. Acute colonic pseudo-obstruction. Gastrointest Endosc. 2002;56:789–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Saunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005;22:917–25.CrossRefPubMedGoogle Scholar
  4. 4.
    Jetmore AB, Timmcke AE, Gathright Jr JB, et al. Ogilvie’s syndrome: colonoscopic decompression and analysis of predisposing factors. Dis Colon Rectum. 1992;35:1135–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Nivatvongs S, Vermeulen FD, Fang DT. Colonoscopic decompression of acute pseudo-obstruction of the colon. Ann Surg. 1982;196:598–600.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Strodel WE, Nostrant TT, Eckhauser FE, et al. Therapeutic and diagnostic colonoscopy in nonobstructive colonic dilatation. Ann Surg. 1983;197:416–21.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Bode WE, Beart Jr RW, Spencer RJ, et al. Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie’s syndrome). Report of 22 cases and review of the literature. Am J Surg. 1984;147:243–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc. 1996;44:144–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Kukora JS, Dent TL. Colonoscopic decompression of massive nonobstructive cecal dilation. Arch Surg. 1977;112:512–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Sloyer AF, Panella VS, Demas BE, et al. Ogilvie’s syndrome. Successful management without colonoscopy. Dig Dis Sci. 1988;33:1391–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Fiorito JJ, Schoen RE, Brandt LJ. Pseudo-obstruction associated with colonic ischemia: successful management with colonoscopic decompression. Am J Gastroenterol. 1991;86:1472–6.PubMedGoogle Scholar
  12. 12.
    ASGE Standards of Practice Committee, Harrison ME, Anderson MA, et al. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc. 2010;71:669–79.CrossRefGoogle Scholar
  13. 13.
    De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg. 2009;96:229–39.CrossRefPubMedGoogle Scholar
  14. 14.
    Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007;21:671–87.CrossRefPubMedGoogle Scholar
  15. 15.
    Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986;29:203–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Bernton E, Myers R, Reyna T. Pseudo-obstruction of the colon. Curr Surg. 1983;40:30–1.PubMedGoogle Scholar
  17. 17.
    Lavignolle A, Jutel P, Bonhomme J, et al. Ogilvie’s syndrome: results of endoscopic exsufflation in a series of 29 cases. Gastroenterol Clin Biol. 1986;10:147–51.PubMedGoogle Scholar
  18. 18.
    Cowlam S, Watson C, Elltringham M, et al. Percutaneous endoscopic colostomy of the left side of the colon. Gastrointest Endosc. 2007;65:1007–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Bertolini D, De Saussure P, Chilcott M, et al. Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: a case report and review of the literature. World J Gastroenterol. 2007;13:2255–7.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Jain A, Vargas HD. Advances and challenges in the management of acute colonic pseudo-obstruction (Ogilvie syndrome). Clin Colon Rectal Surg. 2012;25:37–45.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    vanSonnenberg E, Varney RR, Casola G, et al. Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience. Radiology. 1990;175:679–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.CrossRefPubMedGoogle Scholar
  23. 23.
    Adler DG, Baron TH. Endoscopic palliation of colorectal cancer. Hematol Oncol Clin North Am. 2002;16:1015–29.CrossRefPubMedGoogle Scholar
  24. 24.
    Ansaloni L, Andersson RE, Bazzoli F, et al. Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society. World J Emerg Surg. 2010;5:29.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81:1270–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Mauro MA, Koehler RE, Baron TH. Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology. 2000;215:659–69.CrossRefPubMedGoogle Scholar
  27. 27.
    Targownik LE, Spiegel BM, Sack J, et al. Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc. 2004;60:865–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Riedl S, Wiebelt H, Bergmann U, et al. Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg. 1995;66:597–606.PubMedGoogle Scholar
  29. 29.
    Dudley HA, Racliffe AG, McGeehan D. Intraoperative irrigation of the colon to permit primary anastomosis. Br J Surg. 1980;67:80–1.CrossRefPubMedGoogle Scholar
  30. 30.
    Simmons DT, Baron TH. Technology insight: enteral stenting and new technology. Nat Clin Pract Gastroenterol Hepatol. 2005;2:365–74.CrossRefPubMedGoogle Scholar
  31. 31.
    Lee KM, Shin SJ, Hwang JC, et al. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc. 2007;66:931–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Choi JS, Choo SW, Park KB, et al. Interventional management of malignant colorectal obstruction: use of covered and uncovered stents. Korean J Radiol. 2007;8:57–63.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    ASGE Technology Committee, Varadarajulu S, Banerjee S, et al. Enteral stents. Gastrointest Endosc. 2011;74:455–64.CrossRefGoogle Scholar
  34. 34.
    Repici A, Adler DG, Gibbs CM, et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc. 2007;66:940–4.CrossRefPubMedGoogle Scholar
  35. 35.
    Song HY, Kim JH, Kim KR, et al. Malignant rectal obstruction within 5 cm of the anal verge: is there a role for expandable metallic stent placement? Gastrointest Endosc. 2008;68:713–20.CrossRefPubMedGoogle Scholar
  36. 36.
    Repici A, de Paula Pessoa Ferreira D. Expandable metal stents for malignant colorectal strictures. Gastrointest Endosc Clin N Am. 2011;21:511–33.CrossRefPubMedGoogle Scholar
  37. 37.
    Dohmoto M, Hünerbein M, Schlag PM. Palliative endoscopic therapy of rectal carcinoma. Eur J Cancer. 1996;32A:25–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Zhang Y, Shi J, Shi B, et al. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc. 2012;26:110–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Tilney HS, Lovegrove RE, Purkayastha S, et al. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc. 2007;21:225–33.CrossRefPubMedGoogle Scholar
  40. 40.
    Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, et al. Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc. 2004;18:421–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Baron TH, Dean PA, Yates 3rd MR, et al. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998;47:277–86.CrossRefPubMedGoogle Scholar
  42. 42.
    Lee HJ, Hong SP, Cheon JH, et al. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc. 2011;73:535–42.CrossRefPubMedGoogle Scholar
  43. 43.
    Pearce NW, Scott SD, Karran SJ. Timing and method of reversal of Hartmann’s procedure. Br J Surg. 1992;79:839–41.CrossRefPubMedGoogle Scholar
  44. 44.
    Mitry E, Barthod F, Penna C, et al. Surgery for colon and rectal cancer. Best Pract Res Clin Gastroenterol. 2002;16:253–65.CrossRefPubMedGoogle Scholar
  45. 45.
    Mainar A, De Gregorio Ariza MA, Tejero E, et al. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery--results of a multicenter study. Radiology. 1999;210:65–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Keymling M. Colorectal stenting. Endoscopy. 2003;35:234–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246:24–30.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Keswani RN, Azar RR, Edmundowicz SA, et al. Stenting for malignant colonic obstruction: a comparison of efficacy and complications in colonic versus extracolonic malignancy. Gastrointest Endosc. 2009;69:675–80.CrossRefPubMedGoogle Scholar
  49. 49.
    Kim BK, Hong SP, Heo HM, et al. Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery. Gastrointest Endosc. 2012;75:294–301.CrossRefPubMedGoogle Scholar
  50. 50.
    Shin SJ, Kim TI, Kim BC, et al. Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon Rectum. 2008;51:578–83.CrossRefPubMedGoogle Scholar
  51. 51.
    Adler DG, editor. Self-expanding stents in gastrointestinal endoscopy. Thorofare, NJ: SLACK; 2012.Google Scholar
  52. 52.
    Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc. 2010;71:560–72.CrossRefPubMedGoogle Scholar
  54. 54.
    Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction--causes and contributing factors. Minim Invasive Ther Allied Technol. 2011;20:133–40.CrossRefPubMedGoogle Scholar
  55. 55.
    Manes G, de Bellis M, Fuccio L, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg. 2011;146:1157–62.CrossRefPubMedGoogle Scholar
  56. 56.
    Lo SK. Metallic stenting for colorectal obstruction. Gastrointest Endosc Clin N Am. 1999;9:459–77.PubMedGoogle Scholar
  57. 57.
    Khot UP, Lang AW, Murali K, et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002;89:1096–102.CrossRefPubMedGoogle Scholar
  58. 58.
    Binkert CA, Ledermann H, Jost R, et al. Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents—a preliminary report. Radiology. 1998;206:199–204.CrossRefPubMedGoogle Scholar
  59. 59.
    Solecki R, Zajac A, Richter P, et al. Bifocal esophageal and rectal cancer palliatively treated with argon plasma coagulation. Surg Endosc. 2004;18:346.CrossRefPubMedGoogle Scholar
  60. 60.
    Baumhoer D, Armbrust T, Ramadori G. Nonsurgical treatment of the primary tumor in four consecutive cases of metastasized colorectal carcinoma. Endoscopy. 2005;37:1232–6.CrossRefPubMedGoogle Scholar
  61. 61.
    Small AJ, Young-Fadok TM, Baron TH. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc. 2008;22:454–62.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineHuntsman Cancer Center, University of Utah School of MedicineSalt Lake CityUSA

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