Pseudoobstruction in the geriatric population.
In this time of sophisticated technology, the diagnosis of intestinal obstruction and pseudoobstruction still depends on plain radiographs and barium studies. Old myths and rigid routines interfere with the interpretation of plain radiographic examinations, however. Air-fluid levels can be present in the colon owing to fluid accumulation from prolonged stasis, and they do not necessarily indicate obstruction. Positioning of the patient for diagnostic studies should be directed so that the shifting of gas within the colon gives maximal information about intestinal patency and diameter. Barium studies are only necessary and desirable when the gas pattern suggests a mechanical obstruction. Pseudoobstruction, which tends to be amenable to conservative treatment, is a frequent occurrence in the elderly population. If properly managed, the risk of perforation is low, and invasive procedures can usually be avoided. In the elderly population with poor intestinal tone, colonic caliber is often large; yet some textbooks still quote specific cecal diameters as indicators of impending perforation. Mobilizing the gas with positional maneuvers can help to decrease cecal size, facilitate evacuation, and allay fear. This is one more situation in which the radiologist can play an active role in patient management. Close cooperation with the clinician is necessary to insure optimal care of these difficult and challenging patients.
Adler
Y T
YT
Department of Diagnostic Radiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
Draths
K G
KG
Markey
W S
WS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications; D003110:Colonic Neoplasms / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011187:Posture; D011859:Radiography