Pseudoobstrucción intestinal aguda

espanolLa pseudoobstruccion colonica aguda es una entidad caracterizada por una propulsion intestinal alterada sin causa obstructiva mecanica, que cursa con distension abdominal aguda y dilatacion de asas colonicas. Se da habitualmente en pacientes con enfermedades medicas o quirurgicas graves subyacentes. Su patogenia es desconocida, aunque parece existir un desequilibrio en la regulacion motora simpatica-parasimpatica, existiendo en mas del 90% de los casos factores precipitantes metabolicos, infecciosos, farmacologicos, etc. Su pronostico esta determinado por la gravedad de la enfermedad subyacente y comorbilidades del paciente, asi como por la aparicion de complicaciones (isquemia o perforacion) en cuyo caso la mortalidad alcanza el 40%. El tratamiento inicial es conservador e incluye la instauracion precoz de medidas de vigilancia-soporte y la correccion de factores precipitantes. Debe excluirse la existencia de obstruccion mecanica y la infeccion por Clostridium difficile, y es preciso evaluar periodicamente la presencia de signos de isquemia o perforacion. Si el diametro cecal supera los 10-12 cm o no hay respuesta tras 48 horas, la administracion de neostigmina intravenosa, bajo monitorizacion cardiorrespiratoria, es el tratamiento de eleccion. Aquellos pacientes que fracasan deben someterse a colonoscopia descompresiva, reservandose la cirugia para casos refractarios o con isquemia o perforacion. El ileo postoperatorio es una alteracion transitoria de la motilidad del intestino delgado que suele producirse tras una cirugia intra o extraabdominal y que cursa con signos-sintomas de obstruccion intestinal. Su aparicion implica, ademas de un retraso en la recuperacion del paciente, un aumento en la estancia hospitalaria y un mayor riesgo de complicaciones postoperatorias. Son factores de riesgo la cirugia muy invasiva, el uso rutinario de sonda nasogastrica, el retraso en la realimentacion via oral y la utilizacion de analgesicos opiaceos. Dado que no existe tratamiento especifico, es esencial la prevencion, basada en un abordaje integral sobre los factores de riesgo. EnglishAcute colonic pseudoobstruction is a condition characterized by impaired intestinal propulsion in the absence of a mechanical obstructive cause that leads to acute abdominal distension and dilation of colonic loops. It usually occurs in elderly patients with underlying medical or surgical conditions. Pathogenesis is unknown although it has been suggested to result from an imbalance in the sympathetic-parasympathetic regulation of the colonic motor function, with precipitating factors (metabolic, infectious and pharmacological) in more than 90% of cases. Prognosis is determined by the severity of the underlying disease and comorbidities as well as by the occurrence of complications (ischemia or perforation) in which case the mortality rate reaches 40%. Initial management is conservative and includes early establishment of surveillance-support measures and correction of precipitating factors. Mechanical obstruction and Clostridium difficile infection should be excluded as well as the presence of signs of ischemia or perforation. If cecal diameter exceeds 10-12 cm or there is no response after 48 hours, intravenous neostigmine under cardiorespiratory monitoring is the treatment of choice. Patients who fail medical therapy (or those in which is contraindicated) should undergo decompressive colonoscopy, whereas surgery is reserved for complicated patients by colon ischemia or perforation as well as refractory cases to pharmacological and endoscopic therapies. Postoperative ileus is a transient impairment of small bowel motility that usually occurs after intra or extra-abdominal surgery, which presents with signs and symptoms of intestinal obstruction. It results in a delayed patient recovery; a more prolonged hospital stay and an increased risk of postoperative complications. More invasive surgery, routine use of nasogastric tube, delayed enteral feeding and use of opioid analgesics are common risk factors. Since there is no specific treatment, prevention based on a multimodal approach is essential.