From the Guidelines
Adynamic ileus and colonic pseudo-obstruction are two distinct conditions characterized by a lack of enteric propulsion, but they differ in their underlying causes and clinical manifestations.
Key Differences
- Adynamic ileus is a condition where there is a temporary cessation of the normal contractions of the bowel muscles, often caused by drugs, trauma, postoperative period, metabolic disturbance, and other factors 1.
- Colonic pseudo-obstruction, on the other hand, is a condition where there is a functional obstruction of the colon without any mechanical blockage, often caused by similar factors as adynamic ileus, including medications that affect peristalsis 1.
Diagnostic Considerations
- The diagnosis of these conditions can be challenging, and manometry can be a useful tool in evaluating patients with suspected pseudo-obstruction, as it can detect abnormal contractile activity of the small bowel 1.
- Chronic intestinal pseudo-obstruction (CIPO) is a related condition that can be diagnosed on cross-sectional imaging, with a chronically dilated small bowel 1.
Clinical Implications
- Both adynamic ileus and colonic pseudo-obstruction require careful management, as they can be associated with significant morbidity and mortality, particularly if left untreated or if complications such as ischemia or perforation occur 1.
- Medications that affect peristalsis should be used with caution, as they can contribute to the development of these conditions 1.
From the Research
Definition and Causes
- Adynamic ileus and colonic pseudo-obstruction are two conditions that cause functional obstruction of intestinal transit without mechanical obstruction, due to uncoordinated or attenuated intestinal muscle contractions 2.
- Adynamic ileus usually arises from an exaggerated intestinal reaction to abdominal surgery, often exacerbated by other conditions 2.
- Colonic pseudo-obstruction is induced by metabolic disorders, drugs that inhibit intestinal motility, severe illnesses, and extensive surgery 2.
Clinical Presentation
- Colonic pseudo-obstruction presents with massive colonic dilatation and variable, moderate small bowel dilatation 2.
- Ogilvie's syndrome is a type of pseudo-obstruction of the colon of unknown cause, which can be mimicked by adynamic ileus in its clinical, radiological, and colonoscopic presentations 3.
- Acute pseudo-obstruction of the colon (Ogilvie's syndrome) can occur after instrumental vaginal delivery, and is an adynamic ileus without mechanical obstruction of the bowel 4.
Treatment and Management
- Both adynamic ileus and colonic pseudo-obstruction are initially treated with supportive measures, including intravenous rehydration, correction of electrolyte abnormalities, discontinuation of antikinetic drugs, and treatment of other contributing disorders 2.
- Specific therapies for colonic pseudo-obstruction include neostigmine (an anticholinesterase) for pharmacologic colonic decompression and colonoscopic decompression 2.
- Early diagnosis and appropriate treatment are imperative to avoid complications such as caecal rupture and faecal peritonitis 4, 5.