Acute Colonic Pseudo-Obstruction: A Comprehensive Review

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a rare but potentially life-threatening condition characterized by a large dilation of the colon without any physical blockage. It predominantly affects elderly individuals with multiple underlying health conditions, postoperative patients, and those receiving medications that impact gastrointestinal motility. The exact underlying mechanisms leading to ACPO remain unclear, but it is believed to result from dysfunction in the autonomic neural system, causing impaired colonic motility. Patients with ACPO typically present with symptoms such as abdominal distension, pain, and constipation. The diagnosis of ACPO is established based on clinical assessment, X-ray imaging, and the exclusion of mechanical obstruction. Treatment for ACPO involves promptly identifying and addressing any underlying medical conditions that may contribute to its development, such as correcting electrolyte imbalances or discontinuing medications with gastrointestinal side effects. Non-invasive measures, such as decompressing the colon using a rectal tube or administering a medication called neostigmine, are often effective in relieving symptoms. In refractory cases where conservative measures fail, surgical intervention may be necessary. Despite the rarity of ACPO, its potential for significant morbidity and mortality emphasizes the importance of promptly recognizing and managing the condition. Healthcare providers should exercise caution in patients with risk factors and clinical features suggestive of ACPO. By understanding the pathophysiology and promptly initiating appropriate interventions, healthcare professionals can optimize outcomes and minimize the potential complications associated with ACPO.