Summary
Definition
History and exam
Key diagnostic factors
- cólica abdominal
- distensão abdominal
- náuseas
- vômitos
- alteração nos hábitos intestinais
- presença de fatores de risco
- fezes duras
- fezes moles
- reto vazio
- perda de peso recente
- sangramento retal
- massa retal palpável
- massa abdominal palpável
- abdome timpânico
- ruídos hidroaéreos anormais
- exame de sangue oculto nas fezes positivo
- febre
- desconforto abdominal
- rigidez abdominal
Other diagnostic factors
- tenesmo
Risk factors
- câncer colorretal
- neoplasia maligna atual ou prévia
- doença diverticular
- Volvo de cólon
- doença inflamatória intestinal
- hérnia atual ou prévia
- endometriose
- diabetes
- cirurgia abdominal prévia
- megacólon
- dieta pobre ou rica em fibras
- abuso de laxantes
- radioterapia anterior
- ingestão de corpo estranho
Diagnostic tests
1st tests to order
- TC abdominal e de pelve
- Hemograma completo
- eletrólitos séricos
- proteína C-reativa
- função renal
- glicose
- estudos de coagulação, tipo e perfil, prova cruzada
- gasometria arterial (incluindo lactato)
- amilase/lipase sérica
- radiografia abdominal simples
Tests to consider
- gonadotrofina coriônica humana beta
- urinálise
- ultrassonografia abdominal
- enema com contraste
- endoscopia flexível/rígida
- biópsia
Treatment algorithm
agudamente doente
volvo de sigmoide
volvo cecal
malignidade colorretal
doença diverticular
ingestão de corpo estranho
estenoses benignas
endometriose
abscesso pélvico
atualmente recebendo cuidados paliativos
Contributors
Authors
Adrian A. Maung, MD, MBA, FACS, FCCM
Associate Professor of Surgery
Division of General Surgery, Trauma and Surgical Critical Care
Department of Surgery
Yale School of Medicine
Surgical Director of Perioperative Services
Adult Trauma Medical Director
Yale New Haven Hospital
New Haven
CT
Disclosures
AAM declares that he has no competing interests.
Acknowledgements
Dr Adrian A. Maung would like to gratefully acknowledge Dr George Malietzis, Dr John T. Jenkins, and Dr Alisdair J. MacDonald, previous contributors to this topic.
Disclosures
GM, JTJ, and AJM declare that they have no competing interests.
Peer reviewers
Alessandro Fichera, MD, FACS, FASCRS
Assistant Professor
Department of Surgery
University of Chicago
Chicago
IL
Disclosures
AF declares that he has no competing interests.
Robert H. Diament, MD
Consultant Surgeon
Crosshouse Hospital
Crosshouse
Kilmarnock
UK
Disclosures
RHD declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Alavi K, Poylin V, Davids JS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colonic volvulus and acute colonic pseudo-obstruction. Dis Colon Rectum. 2021 Sep 1;64(9):1046-57.Full text Abstract
Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018 Aug 13;13:36.Full text Abstract
Naveed M, Jamil LH, Fujii-Lau LL, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc. 2020 Feb;91(2):228-35. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Pseudo-obstrução do cólon aguda (síndrome de Ogilvie)
- Megacólon crônico/idiopático
- Megacólon tóxico
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- WSES consensus guidelines on sigmoid volvulus management
- 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation
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