Acute colonic pseudo-obstruction (ACPO) is a syndrome characterized by massive dilation of the colon without mechanical obstruction and without an identifiable cause
Epidemiology
- The incidence of ACPO is estimated at 100 cases per 100,000 admissions
- It is an uncommon postoperative complication, occurring in 0.22%–7% of patients undergoing surgery
Pathophysiology
- The pathophysiology of ACPO is not completely understood but is thought to result from an imbalance in the autonomic regulation of colonic motor function
- Metabolic or pharmacological factors, as well as spinal or retroperitoneal trauma, may alter the autonomic regulation of colonic function, leading to excessive parasympathetic suppression or sympathetic stimulation. This imbalance results in colonic atony and dilation
Clinical manifestations
- ACPO presents as a syndrome of massive dilation of the colon without mechanical obstruction
- The condition can lead to significant complications, including ischemia and perforation, particularly when the cecal diameter exceeds 12 cm and when the distention has been present for more than 6 days
Risk factors
- ACPO usually affects elderly people with underlying comorbidities
- Most patients who develop ACPO after surgery have preoperative conditions and/or have received medications identified as risk factors for ACPO
- The use of patient-controlled analgesia was associated with an earlier development of symptoms
In conclusion, ACPO is a serious condition with significant morbidity and mortality. Early recognition and appropriate management are essential to reduce the occurrence of life-threatening complications