J Korean Med Sci.  2014 May;29(5):699-703. 10.3346/jkms.2014.29.5.699.

The Clinical Characteristics of Colonic Pseudo-obstruction and the Factors Associated with Medical Treatment Response: A Study Based on a Multicenter Database in Korea

• Lee KJ
• Jung KW
• Myung SJ
• Kim HJ
• Kim NY
• Yoon YH
• Sohn CI
• Shin JE
• Cho YK
• Hong SJ
• Lee TH
• Park KS
• Jung HK
• Choi CH
• Kim GH
• Kim JH
• Jo YJ
• Lee JS
• Park HJ

• KMID: 1786113
• DOI: http://doi.org/10.3346/jkms.2014.29.5.699

Abstract

Colonic pseudo-obstruction (CPO) is defined as marked colonic distension in the absence of mechanical obstruction. We aimed to investigate the clinical characteristics of CPO and the factors associated with the response to medical treatment by using a multicenter database in Korea. CPO was diagnosed as colonic dilatation without mechanical obstruction by using radiologic and/or endoscopic examinations. Acute CPO occurring in the postoperative period in surgical patients or as a response to an acute illness was excluded. CPO cases were identified in 15 tertiary referral hospitals between 2000 and 2011. The patients' data were retrospectively reviewed and analyzed. In total, 104 patients (53 men; mean age at diagnosis, 47 yr) were identified. Seventy-seven of 104 patients (74%) showed a transition zone on abdominal computed tomography. Sixty of 104 patients (58%) showed poor responses to medical treatment and underwent surgery at the mean follow-up of 7.4 months (0.5-61 months). Younger age at the time of diagnosis, abdominal distension as a chief complaint, and greater cecal diameter were independently associated with the poor responses to medical treatment. These may be risk factors for a poor response to medical treatment.

Keyword

Colonic Pseudo-obstruction; Abdominal Distension; Colonic Dilatation; Transition Zone

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Colon/*pathology/surgery
Colonic Pseudo-Obstruction/*diagnosis/*pathology/surgery
Constipation/diagnosis
Dilatation, Pathologic
Female
Humans
Male
Middle Aged
Republic of Korea
Retrospective Studies
Sagittal Abdominal Diameter
Tomography, X-Ray Computed
Treatment Outcome
Young Adult

Figure

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  Fig. 1 An example of CPO associated with neuropathy. Simple abdominal radiograph (A) and computed tomography (B) reveal a dilated transverse colon without definite mechanical obstruction. On surgical specimens, the dilated and non-dilated colonic segments with a transition zone (arrow) are observed (C), and ganglion cells are not identified in the myenteric plexus by hematoxylin and eosin staining (×200) (D).

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  Fig. 2 Comparison of age between non-responders and responders. There is a significant difference in the mean age at the time of diagnosis between patients who were not responsive and those who were responsive to medical treatment (42±15 yr vs 53±17 yr, P=0.001).

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  Fig. 3 The presence of abdominal distension as a chief compliant in non-responders and responders. There is a significant difference in the proportion of abdominal distension as a chief complaint between patients who were not responsive and those who were responsive to medical treatment (33% vs 9%, P=0.004).

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