TITLE:
Acute Colonic Pseudo-Obstruction (ACPO): An Expanding Colon with Unusual Risk Factors
AUTHORS:
Kelly Schulte, Alyson Terry, Grace Boyle, Dmitriy Scherbak
KEYWORDS:
Acute Colonic Pseudo-Obstruction, ACPO, Ogilvie’s Syndrome, Colonic Dilation, Acute Embolic Infarcts, Cerebrovascular Accident, Pulmonary Embolism, PE
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.14 No.2,
May
24,
2024
ABSTRACT: The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embolism and embolic stroke is a rarity. A 76-year-old female with shortness of breath, left hemiparesis and right-sided paresthesias presented with acute pulmonary embolism and acute infarcts of the left caudate nucleus, thalamus and occipital lobe. Her hospitalization was complicated with persistent distention of the large bowel without dilation of the small bowel. Empiric antibiotics were initiated without improvement and laboratory studies including Clostridium difficile were negative. She underwent nasogastric decompression and two decompressive colonoscopies with a resolution of her symptoms. This case illustrates an example of acute abdominal distension, without underlying etiology, in the setting of acute embolism of the pulmonary and cerebral vasculature. Early identification and action with decompressive colonoscopy were key to preventing further bowel damage or rupture.