By G. Heberer (auth.), Prof. Dr. med. Georg Heberer, Priv.-Doz. Dr. med. Heiko Denecke (eds.)
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The distension disappeared and did not recur over a period of 6 months. Case 4: A 24 year old woman developed massive abdominal distension 48 hours after caesarian section with a large gasfilled loop of large intestine. The transverse diameter of the cecum was 12 cm in the morning and 19 cm in the afternoon. After exclusion of distal obstruction by gastrografm enema a colonoscopy was performed, which allowed complete decompression of the right colon by aspiration. Biopsies taken from several small lesions of the mucosa of the ascending colon showed superficial mucosal defects with beginning round cell and leucocyte infIltration.
Perforation or widely scattered areas of necrosis make resection mandatory. References 1. Adams JT (1974) Adynamic ileus of the colon: An indication for cecostomy. Arch Surg 109:503 2. Gierson ED, Storm FK, Shaw W (1975) Coecal rupture due to colonic ileus. Br J Surg 62:383 3. Golden TG, Chandler JG (1975) Colonic ileus and cecal perforation in patients requiring mechanical ventilatory support. Chest 68:661 4. Lescher TJ, Teegarden DK, Pruitt BA (1978) Acute pseudo-obstruction of the colon in thermally injured patients.
Approximately 50% of the group had vomited. On x-ray of the abdomen there may be a cut-off of gas near the splenic flexure or rectosigmoid region, suggesting mechanical obstruction. On the other hand there may be gas all the way down to the lower rectum, indicating no true organic obstruction. If the ileocaecal valve is incompetent then there will be associated distended small bowel. Many x-rays are inconclusive and the quality poor, as these x-rays are carried out in elderly and often obese patients.