Acute Pseudo-Obstruction of the Large Bowel

Abstract

Acute pseudo-obstruction may be defined as a condition presenting the classic symptoms and signs and radiological findings of acute large-bowel obstruction where at laparotomy, or on further investigation, no mechanical obstruction is found. This acute abdominal emergency may occur spontaneously, but is usually associated with some pathology else­where in the body. The associated conditions in my series are shown in Table 1. The aetiology of acute pseudo-obstruction of the large bowel is uncertain, and this presents problems of diagnosis and management. There have been many reports of this syndrome in the British surgical literature since 1949, when it was originally called Ogilvie’s syndrome [1]. I have a personal series of 27 patiens, all of whom had colicky abdominal pain, marked abdominal distension with tenderness which was rebound in several patients and x-ray appearances of distended bowel with fluid levels. Approximately 50% of the group had vomited. On x-ray of the abdomen there may be a cut-off of gas near the splenic flexure or rectosigmoid region, suggesting mechanical obstruction. On the other hand there may be gas all the way down to the lower rectum, indicating no true organic obstruction. If the ileocaecal valve is incompetent then there will be associated distended small bowel. Many x-rays are inconclusive and the quality poor, as these x-rays are carried out in elderly and often obese patients. The exact cause of acute pseudo-obstruction of the colon has never been established, but certain observations have been made.