When acute colonic pseudo-obstruction (ACPO) is complicated by overt colonic perforation, signs of peritonitis, or colonic ischemia, the clinical situation is immediately critical and requires a specific, evidence-based management pathway.
This protocol addresses ACPO presenting with one or more of the following high-risk complications:
Surgical management is the recommended course of action in this setting. Several specific surgical options may be considered depending on the individual clinical picture.
The complete selection of procedures, indications for each option, and clinical decision criteria are detailed in the full structured protocol.
DOI: 10.1016/j.gie.2019.09.007
For patients with ACPO with overt perforation or signs of peritonitis, we recommend surgical management.
Patients presenting with peritonitis, ischemia, perforation, clinical deterioration, or cecal diameter greater than 12 cm should also be referred for surgery.
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