Guivarc'h M, Hakim M, Roullet-Audy J C, Mosnier H
Service de Chirurgie Générale et Digestive-CMC FOCH, Suresnes.
J Chir (Paris). 1996 Nov;133(7):301-6.
From twenty six personal cases, the authors make a review of the literature. 92% of their cases are met in a post operative (28%), neurological (28%), general (24%) context, or in intensive care with assisted ventilation (36%). The major symptom is the meteorism (100%) with in one out of three cases, abdominal pain, vomiting, right iliac defense, absence of bowel sounds. Radiological distension involves mostly the right colon and the coecum (28%), right and transverse colon (40), sometimes the whole colon (32%). The mean diameter of the coecum reached 12 cm (9 to 25 cm). Early coloscopy was mandatory in 20 patients, of which 14 were cured, 13 patients were operated on, for suspicion of ischemia or perforation, because incertain diagnosis, or failure of colonoscopy. Ceocostomy or right hemicolectomy (55%) were performed rather than transverse colostomy. The surgical approach must be adapted to the anatomical lesions. Total mortality was 4% in this series. Early diagnosis of pseudo obstruction, early colonoscopy with intubation must allow to avoid surgery.
作者通过26例个人病例对文献进行了回顾。他们的病例中92%出现在术后（28%）、神经科（28%）、普通科室（24%）的背景下，或在重症监护且使用辅助通气的情况下（36%）。主要症状是肠胀气（100%），三分之一的病例伴有腹痛、呕吐、右髂部压痛、肠鸣音消失。放射学上的扩张主要累及右结肠和盲肠（28%）、右结肠和横结肠（40%），有时累及整个结肠（32%）。盲肠的平均直径达12厘米（9至25厘米）。20例患者必须尽早进行结肠镜检查，其中14例治愈，13例因怀疑缺血或穿孔、诊断不确定或结肠镜检查失败而接受手术。行盲肠造口术或右半结肠切除术（55%）而非横结肠造口术。手术方式必须根据解剖学病变进行调整。该系列的总死亡率为4%。假性肠梗阻的早期诊断、早期带插管的结肠镜检查必须能够避免手术。
