Update on the Diagnosis and Management of Acute Colonic Pseudo-obstruction (ACPO).

Q1 Medicine
Ahana Sen, Reena Chokshi
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引用次数: 0

Abstract

Purpose of review: Acute Colonic Pseudo-obstruction (ACPO) is a cause of large intestinal dilation and obstruction without any physical transition point. It remains difficult to diagnose and treat. We review the recent updates on diagnosis and management of ACPO.

Recent findings: Recent guidelines have posited that conservative management can be tried in most cases of ACPO, but that early decompression and surgery should be considered. Use of neostigmine is still a viable option but there is also promising data on pyridostigmine as well as prucalopride. Resolution of ACPO should be followed by daily use of polyethylene glycol (PEG) to help prevent recurrence. ACPO warrants early and accurate diagnosis with exclusion of alternate causes of large bowel dilation. Conservative management can be attempted for 48-72 h in those with cecal diameters < 12 cm and without signs of peritonitis and perforation. Early escalation of management should be attempted with neostigmine followed by endoscopy and/or surgery as needed, given that longer periods of dilation are associated with worse outcomes. There is promising new evidence for use of pyridostigmine and prucalopride, but further trials are needed prior to incorporating them into regular use. Finally, studies are lacking regarding prevention of ACPO after initial resolution.

急性结肠假性梗阻(ACPO)的诊断和治疗进展。
回顾目的:急性结肠假性梗阻(Acute Colonic pseudo -梗阻,ACPO)是一种没有任何物理过渡点的大肠扩张和梗阻的病因。它仍然难以诊断和治疗。我们回顾了ACPO的诊断和治疗的最新进展。最近的发现:最近的指南认为大多数ACPO病例可以尝试保守治疗,但应考虑早期减压和手术。使用新斯的明仍然是一种可行的选择,但吡多斯的明和普芦卡必利也有令人鼓舞的数据。解决ACPO后应每日使用聚乙二醇(PEG),以帮助防止复发。ACPO需要早期和准确的诊断,排除大肠扩张的其他原因。盲肠直径较大的患者可尝试保守治疗48-72小时
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来源期刊
Current Gastroenterology Reports
Current Gastroenterology Reports Medicine-Gastroenterology
CiteScore
7.80
自引率
0.00%
发文量
19
期刊介绍: As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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