Acute pseudo-obstruction of the colon in thermally injured patients

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Five (1 per cent) of 529 thermally injured patients experienced pseudo-obstruction of the colon over a two-year period. All patients had classic non-painful abdominal distention. Infection was the most common associated problem and possible triggering mechanism in these patients. After confirmation of the colonic dilation on a plain abdominal roentgenogram, distal obstruction was ruled out by contrast enema. Occasionally, Gastrografin enema seemed to ameliorate the distention.

Conservative medical management should be attempted initially. Colonoscopy should be employed at the earliest possible time. Exploratory laparotomy and tube cecostomy are usually adequate when surgical decompression is necessary.

Patients who have accompanying small-intestinal distention seemed to tolerate this condition better, possibly due to a decompressing effect of an incompetent ileocecal valve. “Hinge-type” kinks, which occur in time at both hepatic and splenic flexures, become obstructing in themselves, and can be a barrier to conservative treatment.

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