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      Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms

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          Abstract

          AIM

          To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO).

          METHODS

          A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken.

          RESULTS

          No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors.

          CONCLUSION

          Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.

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          Neostigmine for the treatment of acute colonic pseudo-obstruction.

          J Ponec, D Saunders, M Kimmey (1999)
          Acute colonic pseudo-obstruction -- that is, massive dilation of the colon without mechanical obstruction -- may develop after surgery or severe illness. Although it may resolve with conservative therapy, colonoscopic decompression is sometimes needed to prevent ischemia and perforation of the bowel. Uncontrolled studies have suggested that neostigmine, may be an effective treatment. We studied 21 patients with acute colonic pseudo-obstruction. All had abdominal distention and radiographic evidence of colonic dilation, with a cecal diameter of at least 10 cm, and had had no response to at least 24 hours of conservative treatment. We randomly assigned 11 to receive 2.0 mg of neostigmine intravenously and 10 to receive intravenous saline. A physician who was unaware of the patients' treatment assignments recorded clinical response (defined as prompt evacuation of flatus or stool and a reduction in abdominal distention), abdominal circumference, and measurements of the colon on radiographs. Patients who had no response to the initial injection were eligible to receive open-label neostigmine three hours later. Ten of the 11 patients who received neostigmine had prompt colonic decompression, as compared with none of the 10 patients who received placebo (P<0.001). The median time to response was 4 minutes (range, 3 to 30). Seven patients in the placebo group and the one patient in the neostigmine group without an initial response received open-label neostigmine; all had colonic decompression. Two patients who had an initial response to neostigmine required colonoscopic decompression for recurrence of colonic distention; one eventually underwent subtotal colectomy. Side effects of neostigmine included abdominal pain, excess salivation, and vomiting. Symptomatic bradycardia developed in two patients and was treated with atropine. In patients with acute colonic pseudo-obstruction who have not had a response to conservative therapy, treatment with neostigmine rapidly decompresses the colon.
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            Diabetic gastrointestinal motility disorders and the role of enteric nervous system: current status and future directions.

            S Yarandi, S K Srinivasan (2014)
            Gastrointestinal manifestations of diabetes are common and a source of significant discomfort and disability. Diabetes affects almost every part of gastrointestinal tract from the esophagus to the rectum and causes a variety of symptoms including heartburn, nausea, vomiting, abdominal pain, diarrhea and constipation. Understanding the underlying mechanisms of diabetic gastroenteropathy is important to guide development of therapies for this common problem. Over recent years, the data regarding the pathophysiology of diabetic gastroenteropathy is expanding. In addition to autonomic neuropathy causing gastrointestinal disturbances the role of enteric nervous system is becoming more evident.
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              Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases.

              V Vanek, M. Salti (1986)
              This study analyzes 400 cases of acute pseudo-obstruction of the colon (Ogilvie's syndrome). Seven cases were reported at St. Elizabeth Hospital Medical Center between October 1982 and February 1985; 393 cases were reported in the literature from 1970-1985. Ogilvie's syndrome is most commonly reported in patients in the sixth decade, and is more predominant in men. It is caused by an unknown disturbance to the autonomic innervation of the distal colon, and is associated with different conditions. Plain abdominal roentgenogram is the most useful diagnostic test. If the cecal diameter is 12 cm or greater, or conservative management is unsuccessful, colonoscopic or operative decompression is needed. The mode of treatment, age, cecal diameter, delay in decompression, and status of the bowel significantly influence the mortality rate, which is approximately 15 percent with early appropriate management, compared with 36 to 44 percent in perforated or ischemic bowel.
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Gastroenterol
                Journal ID (iso-abbrev): World J. Gastroenterol
                Journal ID (publisher-id): WJG
                Title: World Journal of Gastroenterology
                Publisher: Baishideng Publishing Group Inc
                ISSN (Print): 1007-9327
                ISSN (Electronic): 2219-2840
                Publication date (Print): 14 August 2017
                Publication date (Electronic): 14 August 2017
                Volume: 23
                Issue: 30
                Pages: 5634-5644
                Affiliations
                Cameron I Wells, Gregory O’Grady, Ian P Bissett, Department of Surgery, University of Auckland, Auckland 1010, New Zealand
                Gregory O’Grady, Ian P Bissett, Department of Surgery, Auckland District Health Board, Auckland 1010, New Zealand
                Author notes

                Author contributions: All authors contributed to conception and design of the study; Wells CI acquired and analysed data; all authors contributed to interpretation of data, drafting and revising of the manuscript; all authors have given final approval of the version of the article to be published.

                Correspondence to: Dr. Ian P Bissett, Professor, Department of Surgery, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, Auckland 1010, New Zealand. i.bissett@ 123456auckland.ac.nz

                Telephone: +64-9-3737599-89821 Fax: +64-9-3779656

                Article
                Other ID: jWJG.v23.i30.pg5634
                DOI: 10.3748/wjg.v23.i30.5634
                PMC ID: 5558126
                PubMed ID: 28852322
                SO-VID: c08a6fa7-0e14-4569-aae1-4848c6f88117
                Copyright © ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 26 May 2017
                Date revision received : 29 June 2017
                Date accepted : 22 July 2017
                Categories
                Subject: Systematic Reviews

                Keywords: acute colonic pseudoobstruction,acute colonic pseudo-obstruction,colonic,intestinal,pseudo obstruction,ogilvie’s syndrome,pseudo-obstruction
                Data availability:
                Keywords: acute colonic pseudoobstruction, acute colonic pseudo-obstruction, colonic, intestinal, pseudo obstruction, ogilvie’s syndrome, pseudo-obstruction

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