Endoscopic Decompression in Colonic Distension

<b><i>Background:</i></b> Acute colonic distension is a medical emergency with high morbidity and mortality. Clinically important causes of colonic distension are acute colonic pseudo-obstruction, colonic volvulus, and malignant obstruction. Endoscopic decompression is one established therapeutic strategy. <b><i>Summary:</i></b> This therapeutic review will give an overview of possible therapeutic strategies based on the recently published literature, focusing on endoscopic decompression and summarizing the other therapeutic possibilities. The review discusses separately the therapeutic options of acute colonic pseudo-obstruction, colonic volvulus, and malignant obstruction, providing an evidence-based orientation for clinical use. <b><i>Key Messages:</i></b> Endoscopic decompression of colonic distension is an established therapy with high clinical success. The technique and its position in the therapy sequence differ depending on the medical condition, the trigger of the colonic distension, and the local expertise.

Dynamic chronic rectal obstruction causing a severe colonic dilatation in a cat

Case summary A 5-year-old male neutered domestic shorthair cat was presented to our referral centre with a 13 month history of chronic tenesmus due to malunion of the right caudal iliac body. Constipation and pelvic canal stenosis were initially addressed by the referring veterinarian with a right femoral head and neck excision and a right acetabulectomy without observable clinical improvement. At admission, abdominal radiographs revealed severe colonic distension and a narrowed pelvic canal caused by the right proximal femur. Rectal examination and colonography revealed a dynamic compression of the rectum, which worsened with femoral abduction and improved with femoral adduction. A right hindlimb amputation was performed to relieve the obstruction. The cat defaecated 2 days postoperatively and was discharged uneventfully. Neither faecal tenesmus nor dyschaezia were observed over the following 10 months. Relevance and novel information The dynamic nature of the rectal obstruction most likely prevented the development of an irreversible colonic dilatation leading to a megacolon. This is the first report describing a chronic dynamic rectal compression, which was successfully managed with a right hindlimb amputation without the need for subtotal colectomy.

Colonic pseudo-obstruction; Ogilvie syndrome; neostigmine; decompression; caecostomy

<p class="BodyText1">Acute colonic pseudo-obstruction is characterised by massive colonic distension without distal mechanical obstruction. It affects a wide variety of patients who often have multiple comorbidities, which makes studies on pseudo- obstruction difficult to perform and interpret. Few advances have been made in recent years in our understanding and management, which remain challenging. This article explores and provides interpretation of the key studies and concepts that have shaped our management of this condition. </p>