Management of Colonic Pseudo-Obstruction

A diagnosis of colonic pseudo-obstruction (CPO) should be suspected in patients presenting with signs of large bowel obstruction in whom other causes of obstruction (particularly mechanical) have been ruled out. In the absence of bowel perforation or ischemia, initial management strategies involve correction of electrolyte derangements and cessation of any instigating medications, followed by intravenous neostigmine and finally endoscopic decompression. For patients with perforation or nonviable colon, surgical intervention is the standard of care.