Management of acute colonic pseudo-obstruction: opportunities to improve care?

Abstract

Background: Acute colonic pseudo-obstruction (ACPO) is a functional bowel obstruction characterised by colonic dilatation in the absence of mechanical obstruction on imaging. Complications include bowel ischaemia, perforation and death. The aim of this study was to explore outcomes for patients treated for ACPO and to assess adherence to current ACPO treatment guidelines.

Methods: This is a retrospective service evaluation and included patients with a diagnosis of ACPO between 1 March 2018 and 31 March 2023. Process measures were identified following discussion with the clinical team from published guidance. Patients were identified using clinical coding and radiological text reports. Cases were eligible for inclusion if they had radiologically confirmed ACPO. Data were collected following review of patient notes into Microsoft Excel. Descriptive analysis was performed with no formal statistical assessment.

Results: A total of 45 patients were identified, of whom 13 were admitted under general surgery. All patients received admission bloods (n=45). Nearly all patients had computed tomography imaging (43/45, 96%). Only 3/45 (6.7%) of the patients received optimal conservative management (intravenous infusion, nil by mouth, flatus tube, treatment of reversible causes). In all, 11/45 (24%) required further treatment, of whom 7 received this within 72 h. The leading (11/45) complication following diagnosis of ACPO was hospital-acquired pneumonia. Mortality was seen in 9/45.

Conclusions: ACPO is often managed remotely by general surgeons. This may impact on the quality of conservative management, and timeliness of endoscopic or pharmacological intervention. Further work is needed to optimise management.

Keywords: Outcomes; Pseudo-obstructions.

Figure 1

Process flow chart ACPO = acute colonic pseudo-obstruction.

Figure 2

Graph showing time from diagnosis of ACPO to bowels opening signifying resolution of ACPO by treatment type. For two patients, bowel motions were not documented but the patients were ACPO resolved according to their discharge letters. ACPO = acute colonic pseudo-obstruction.

Figure 3

Conservative management. A graph demonstrating the proportion of patients receiving optimal conservative management broken down by treatment modality.