Acute pseudo-obstruction of the colon in thermally injured patients |
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Authors: | Thomas J Lescher MD Major MC David K Teegarden MD Major MC Basil A Pruitt Jr MD Colonel MC |
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Institution: | (1) Brooke Army Medical Center, US Army Institute of Surgical Research, 78234 Fort Sam Houston, Texas |
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Abstract: | Summary and Conclusions Five (1 per cent) of 529 thermally injured patients experienced pseudo-obstruction of the colon over a two-year period. All
patients had classic non-painful abdominal distention. Infection was the most common associated problem and possible triggering
mechanism in these patients. After confirmation of the colonic dilation on a plain abdominal roentgenogram, distal obstruction
was ruled out by contrast enema. Occasionally, Gastrografin enema seemed to ameliorate the distention.
Conservative medical management should be attempted initially. Colonoscopy should be employed at the earliest possible time.
Exploratory laparotomy and tube cecostomy are usually adequate when surgical decompression is necessary.
Patients who have accompanying small-intestinal distention seemed to tolerate this condition better, possibly due to a decompressing
effect of an incompetent ileocecal valve. “Hinge-type” kinks, which occur in time at both hepatic and splenic flexures, become
obstructing in themselves, and can be a barrier to conservative treatment.
Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, June 11 to 15, 1978.
The opinions or assertions contained herein are the private view of the authors and are not to be construed as official or
as reflecting the view of the Department of the Army or the Department of Defense. |
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