title: Acute colonic pseudo-obstruction in pregnancy.
abstract: BACKGROUND
  Acute colonic pseudo-obstruction is an uncommon but potentially morbid complication of pregnancy. The aim of the study was to review a single institution's experience with acute colonic pseudo-obstruction in post-partum patients and develop an algorithm for management based on a literature review.
  
  
  METHODS
  This is a retrospective study where patients were identified over a 2-year period (1 December 2012 to 31 November 2014) by checking all deliveries in Christchurch Women's Hospital against diagnosis codes for bowel obstruction and ileus. Clinical records and radiology were then reviewed to identify those with acute colonic pseudo-obstruction and the management of these patients was reviewed.
  
  
  RESULTS
  Over the study period, seven patients were identified from 10,240 deliveries. Two patients required laparotomy and the rest resolved without surgical intervention. One patient was treated with neostigmine and three with erythromycin. One patient had an unsuccessful attempt at endoscopic decompression, however, symptoms resolved without further intervention following this. A management algorithm was developed based on the literature review.
  
  
  CONCLUSIONS
  Acute colonic pseudo-obstruction occurs in post-partum patients more frequently than suspected (one in 1500 deliveries). The management needs to be active with early correction of electrolyte abnormalities, avoidance of narcotic pain relief and early mobilization. Timely administration of neostigmine or endoscopic decompression can reduce the incidence of colonic ischaemia and perforation and the need for surgical intervention.
authors.affiliation: Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Reeves
authors.affiliation: Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand.
authors.forename: Frank
authors.initials: F
authors.lastname: Frizelle
authors.affiliation: Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wakeman
authors.affiliation: Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand.
authors.forename: Catherine
authors.initials: C
authors.lastname: Parker
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000000981:diagnostic imaging; D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002585:Cesarean Section / Q000379:methods; D003112:Colonic Pseudo-Obstruction / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007813:Laparotomy / Q000379:methods; D009388:Neostigmine / Q000627:therapeutic use; D010277:Parasympathomimetics / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010277:Parasympathomimetics; D009388:Neostigmine; D004917:Erythromycin
keywords: Ogilvie's syndrome; cesarean section; colonic pseudo-obstruction; pregnancy