Parameters:
(1) cecal diameter in cm
(2) time to decompression
Criteria for decompression - at least 1 of the following:
(1) cecal diameter > 12 cm
(2) failure to improve with conservative management at 72 hours
Risk factors for mortality:
(1) cecal diameter > 14 cm
(2) time to decompression > 7 days
(3) bowel rupture
(4) debilitation and/or severe comorbidity
Interventions:
(1) Colonoscopy is effective for decompression if done carefully.
(2) A tube cecostomy is effective if colonoscopy fails or if there is a small bowel perforation.
(3) If the bowel is ischemic or has perforated, then colonic resection with or without anastomosis is required.
