Abstract：
OBJECTIVE: Acute Colonic Pseudo-obstruction (ACPO) is a cause of large intestinal dilation and obstruction without any physical transition point. It remains difficult to diagnose and treat. We review the recent updates on diagnosis and management of ACPO.
RESULTS: Recent guidelines have posited that conservative management can be tried in most cases of ACPO, but that early decompression and surgery should be considered. Use of neostigmine is still a viable option but there is also promising data on pyridostigmine as well as prucalopride. Resolution of ACPO should be followed by daily use of polyethylene glycol (PEG) to help prevent recurrence. ACPO warrants early and accurate diagnosis with exclusion of alternate causes of large bowel dilation. Conservative management can be attempted for 48-72 h in those with cecal diameters < 12 cm and without signs of peritonitis and perforation. Early escalation of management should be attempted with neostigmine followed by endoscopy and/or surgery as needed, given that longer periods of dilation are associated with worse outcomes. There is promising new evidence for use of pyridostigmine and prucalopride, but further trials are needed prior to incorporating them into regular use. Finally, studies are lacking regarding prevention of ACPO after initial resolution.
RESULTS: Recent guidelines have posited that conservative management can be tried in most cases of ACPO, but that early decompression and surgery should be considered. Use of neostigmine is still a viable option but there is also promising data on pyridostigmine as well as prucalopride. Resolution of ACPO should be followed by daily use of polyethylene glycol (PEG) to help prevent recurrence. ACPO warrants early and accurate diagnosis with exclusion of alternate causes of large bowel dilation. Conservative management can be attempted for 48-72 h in those with cecal diameters < 12 cm and without signs of peritonitis and perforation. Early escalation of management should be attempted with neostigmine followed by endoscopy and/or surgery as needed, given that longer periods of dilation are associated with worse outcomes. There is promising new evidence for use of pyridostigmine and prucalopride, but further trials are needed prior to incorporating them into regular use. Finally, studies are lacking regarding prevention of ACPO after initial resolution.
摘要：
目的：急性结肠假性梗阻（ACPO）是引起大肠扩张和梗阻的原因，没有任何物理转变点。它仍然难以诊断和治疗。我们回顾了有关ACPO诊断和管理的最新进展。
结果：最近的指南认为，在大多数ACPO病例中，可以尝试保守管理，但是应该考虑早期减压和手术。使用新斯的明仍然是可行的选择，但关于吡啶斯的明和普鲁卡必利的数据也很有希望。ACPO的解决后，应每天使用聚乙二醇（PEG），以帮助防止复发。ACPO保证早期和准确的诊断，排除大肠扩张的其他原因。对于盲肠直径<12cm且没有腹膜炎和穿孔迹象的患者，可以尝试保守治疗48-72小时。应尝试使用新斯的明进行早期升级管理，然后根据需要进行内窥镜检查和/或手术。考虑到更长的扩张时间与更差的结果相关。有希望的新证据表明使用吡啶斯的明和普鲁卡必利，但在将其纳入常规使用之前还需要进一步的试验.最后,初步解决后，缺乏关于预防ACPO的研究。
结果：最近的指南认为，在大多数ACPO病例中，可以尝试保守管理，但是应该考虑早期减压和手术。使用新斯的明仍然是可行的选择，但关于吡啶斯的明和普鲁卡必利的数据也很有希望。ACPO的解决后，应每天使用聚乙二醇（PEG），以帮助防止复发。ACPO保证早期和准确的诊断，排除大肠扩张的其他原因。对于盲肠直径<12cm且没有腹膜炎和穿孔迹象的患者，可以尝试保守治疗48-72小时。应尝试使用新斯的明进行早期升级管理，然后根据需要进行内窥镜检查和/或手术。考虑到更长的扩张时间与更差的结果相关。有希望的新证据表明使用吡啶斯的明和普鲁卡必利，但在将其纳入常规使用之前还需要进一步的试验.最后,初步解决后，缺乏关于预防ACPO的研究。
