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Acute Colonic Pseudo-obstruction

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Intestinal Pseudo-obstruction: Intestinal pseudo-obstruction refers to a condition that mimics intestinal obstruction clinically and radiologically in the absence of a mechanical cause. Acute Colonic Pseudo-obstruction - aka Ogilvie's syndrome (which is the diagnosis in this case) is usually seen in elderly patients with severe underlying disorders. There is massive dilatation of large bowel without evidence of mechanical obstruction. Cecum and right colon are more often involved. Small intestine and left colon are less affected. If the condition is recognized early and treated aggressively, complications such as perforation can be avoided and normal intestinal function restored.

The terms megacolon and megarectum refer to the radiologic or intraoperative appearance of chronically dilated colon or rectum. The underlying causes include pseudo-obstruction, inflammation, infection, spinal trauma, metabolic disorders, and congenital disorders (e.g. Hirschsprung's disease).

Case History: This patient in his sixties presented with acute abdominal pain and distension. Imaging studies showed marked enlargement of recto-sigmoid segment with air under diaphragm. Emergency laparotomy was performed. The resected specimen showed massively dilated recto-sigmoid measuring 70 cm in length and 30 cm in diameter. The serosal surface had adhesions and a shaggy exudate. The mucosal folds were flattened and there was an area of perforation. The exact etiology of intestinal pseudo-obstruction in this case was not known.

Case courtesy of: Dr. Sanjay D. Deshmukh (Professor of Pathology) and Dr. Jayant M. Gadekar (Professor and Head of Surgery), Dr. Vithalrao Vikhe Patil Medical College and Hospitals, Ahmednagar, India.

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