Patient selection: acute colonic pseudo-obstruction
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Initial Assessment
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Management
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peritoneal signs or other evidence of colonic perforation
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surgery
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positive response to conservative management
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confirm resolution and monitor for recurrence
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failure of conservative therapy within 24 or 48 hours
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prokinetic drug administration OR decompression by colonoscopy OR cecostomy
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Conservative management steps:
(1) nothing by mouth (NPO)
(2) insert nasogastric tube
(3) insert rectal flatus tube
(4) adjust posture and ambulate if possible
(5) correct any electrolyte imbalance
(6) correct any predisposing cause
(7) stop or change contributory drugs (opioids, anticholinergics, etc)
Patients who may not be candidates for intravenous neostignmine as prokinetic drug:
(1) bradycardia
(2) low systolic blood pressure
(3) renal insufficiency
(4) bronchospasm
(5) bowel ischemia, perforation or obstruction
(6) uncontrolled cardiac arrhythmias
(7) inability to provide cardiac monitoring during administration
