Department of Medicine, Section of Gastroenterology & Hepatology, Baylor College of Medicine, 7200 Cambridge Avenue, Suite 8B, Houston, TX, 77030, USA.
Curr Gastroenterol Rep. 2023 Sep;25(9):191-197. doi: 10.1007/s11894-023-00881-w. Epub 2023 Jul 24.
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 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）是一种无明显物理梗阻点的大肠扩张和梗阻的原因。其诊断和治疗仍然具有挑战性。我们对 ACPO 的诊断和治疗的最新进展进行了综述。
最近的指南提出，在大多数 ACPO 病例中可以尝试保守治疗，但应考虑早期减压和手术。新斯的明的使用仍然是一种可行的选择，但吡啶斯的明和普芦卡必利也有很有前途的资料。ACPO 缓解后，应每天使用聚乙二醇（PEG）以帮助预防复发。ACPO 需要早期准确诊断，并排除大肠扩张的其他原因。对于盲肠直径 < 12cm 且无腹膜炎和穿孔迹象的患者，可以尝试保守治疗 48-72 小时。如果有更长时间的扩张，应尝试先用新斯的明进行早期治疗升级，然后根据需要进行内镜检查和/或手术，因为更长时间的扩张与更差的结果相关。吡啶斯的明和普芦卡必利的使用有新的有希望的证据，但在将其纳入常规使用之前，还需要进一步的试验。最后，关于初始缓解后 ACPO 的预防，目前还缺乏研究。
