• Massive colonic distention in the absence of mechanical obstruction
• Severe form of ileus
• May result from autonomic imbalance
• Aerophagia and impairment of colonic motility by drugs are contributing factors
• Diagnosis of exclusion
• Most common in bedridden, elderly patients; following orthopedic injuries; in patients taking psychotropic medications or narcotics
• Associated with metabolic disorders:
• Associated with collagen vascular diseases:
• Abdominal distention without pain or tenderness initially
• Later symptoms may mimic obstruction: abdominal pain, tenderness
• Tympanitic abdomen
• Peritoneal signs indicate bowel compromise and/or perforation
• Bowel sounds often diminished or absent
• May reveal electrolyte abnormalities (especially magnesium and potassium)
• WBC count usually normal, but an elevation may indicate bowel compromise
• Abdominal x-ray: Marked gaseous distention of colon, especially right colon
• Contrast enema: Absence of mechanical obstruction
• Mechanical obstruction
• Hirschsprung disease
• Toxic megacolon
• Fecal impaction
• Rule out mechanical obstruction
• Review medication history
• Obtain abdominal x-ray
• Contrast enema to determine presence of mechanical obstruction
• NG decompression and aggressive enema regimen: Resolution in 86% of patients
• Bowel rest
• Rectal tube placement
• Correct metabolic abnormalities
• Discontinue medications that decrease motility
• Colonoscopic decompression if cecum dilated > 9–10 cm
• If performing colonoscopy, use minimal to no air insufflation
• May place long decompression tube at colonoscopy (Miller or Cantor tube)
• Ensure adequate volume status
• Remove or drain septic collections/abscesses
• Failure to reduce dilation following conservative measures and endoscopic intervention
• Laparotomy should be performed in patients with peritonitis, nonviable bowel
• Perforated cecum may require ileocecectomy, end ileostomy, and mucus fistula
• Nonperforated cecum may be managed with tube cecostomy
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