Massive acute colonic pseudo-obstruction successfully managed with conservative therapy in a patient with cerebral palsy

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome or acute colonic ileus, is a serious condition that can be relatively easily misdiagnosed and a patient's presentation ascribed to both minor conditions, such as functional constipation, and major conditions, like mechanical bowel obstruction. It is important for the emergency physician to be familiar with this entity and its management in order to avoid unnecessary morbidity in these cases.Acute colonic pseudo-obstruction is a distention of the colon caused by decreased motility in the absence of mechanical obstruction. ACPO commonly occurs in association with a severe medical or surgical illness. Other causes include immobility, medications, electrolyte disturbances, and chronic illnesses that directly affect bowel motility. In an article by Vanek and Al-Salti, a review of 393 cases revealed a mean age in the mid to late 50s, and only 5.5% of patients presented without a known associated cause [1]. In this study 35.9% of the cases were associated with either a surgical or obstetrical procedure, and non-operative trauma was associated with 11.3% of cases. Untreated cases may result in the development of bowel perforation in up to 15%, resulting in a mortality rate of around 50% [2].Cerebral palsy has been shown to be associated with a high rate of chronic constipation. An article by Veugelers et al. quotes an outpatient incidence as high as 74% in patients with CP, and there appears to be a neural component to the observed colonic dysmotility [3]. In a study by Johanson et al., neurological disease causing damage to the central nervous system was identified as an important independent risk factor [4]. These factors could predispose these patients to development of ACPO.Symptoms of ACPO include nausea, vomiting, abdominal pain, constipation, diarrhea, and fever. Patients with the complications of ischemic bowel and perforation do not have significantly different presentations than those without