title: Acute Colonic Pseudo-Obstruction with Feeding Intolerance in Critically Ill Patients: A Study according to Gut Wall Analysis.
abstract: Objective. To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening.Methods. ACPO patients with feeding tolerance were divided into ACPO with no obvious gut wall thickening (ACPO-NT) group and ACPO with obvious acute gut wall thickening (ACPO-T) group according to computed tomography and abdominal radiographs. Patients' condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared.Results. Patients in ACPO-T group had a significantly higher APACHE II (11.82 versus 8.25,p= 0.008) and SOFA scores (6.47 versus 3.54,p< 0.001) and a significantly higher 28-day mortality (17.78% versus 4.16%,p= 0.032) and longer intensive care unit stage (4 versus 16 d,p< 0.001). Patients in ACPO-NT group were more likely to be responsive to supportive treatment (62.50% versus 24.44%,p< 0.001), neostigmine (77.78% versus 17.64%,p< 0.001), and colonoscopic decompression (75% versus 42.86%,p= 0.318) than those in ACPO-T group. Of the patients who underwent ileostomy, 81.25% gained benefits.Conclusions. ACPO patients with gut wall thickening are more severe and are less likely to be responsive to nonsurgical treatment. Ileostomy may be a good option for ACPO patients with gut wall thickening who are irresponsive to nonsurgical treatment.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China; Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China.
authors.forename: Chenyan
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China; Southern Medical University, No. 1023 Shatai South Road, Guangzhou 510515, China.
authors.forename: Tingbin
authors.initials: T
authors.lastname: Xie
authors.affiliation: Jining No.1 People's Hospital, No. 99 Jianshe West Road, Jining 272000, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China; Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China.
authors.forename: Minhua
authors.initials: M
authors.lastname: Cheng
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China.
authors.forename: Jialiang
authors.initials: J
authors.lastname: Shi
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Gao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China.
authors.forename: Fengchan
authors.initials: F
authors.lastname: Xi
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China.
authors.forename: Juanhong
authors.initials: J
authors.lastname: Shen
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China; Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Cao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China; Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China.
authors.forename: Wenkui
authors.identifier: 0000-0002-5603-1557
authors.initials: W
authors.lastname: Yu