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ACUTE COLONIC PSEUDO‐OBSTRUCTION (ACPO): SURGERY REMAINS AN IMPORTANT TREATMENT OPTION
Author(s) -
Chow Z. Y.,
Lee H. S.,
Jones I.,
Hastie I.,
Hayes I.,
Shedda S.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04917_24.x
Subject(s) - medicine , neostigmine , surgery , decompression , enema , colonic pseudo obstruction , radiological weapon , mortality rate , anesthesia
Purpose: ACPO often occurs in patients with serious comorbidities and can result in high morbidity and mortality. We aimed to evaluate the current practice of treatment of pseudo obstruction in the era of neostigmine in a single metropolitan hospital. Method: A retrospective review of prospective hospital databases was undertaken to identify patients with radiological evidence of pseudo‐obstruction and gather demographic information. Further information was retrieved from patient files. Results: 133 patients were identified with radiological evidence of pseudo‐obstruction from June 1996 to December 2008. The median age was 68.5 (range 17–95). There were 80 (60%) males. Overall median length of stay was 37 days with a mortality rate of 9%. For conservative treatment or neostigmine (CN), endoscopic decompression (E), surgery (S) groups, the mortality rates were 9.5%, 8.6% and 6.2% respectively, p = 0.36. There were 94 patients in the CN group, 16 (12%) required surgery (S) and 23 (17%) had endoscopy (E), p = 0.36. The median time to diagnosis from admission was 10 days (CN), 0 days (E) and 7 days (S); p = 0.13. The most frequent mode of diagnosis was gastrograffin enema for CN (43), AXR for E (9) and CT abdomen for S (7). It was noted that 44 (33%) patients had unrelated surgery within the last 30 days prior to the current admission. Surgery for complications was required including 7 colectomies (44%) and 5 caecostomies (31%). Conclusion: Surgery remains crucial as a treatment modality for pseudo‐obstruction in the era of neostigmine. The majority of operations performed at our institution for pseudo‐obstruction were colectomies, which reflects a high rate of complications in our cohort of patients.