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October 1974

Adynamic Ileus of the Colon: An Indication for Cecostomy

Author Affiliations

From the Department of Surgery, University of Rochester Medical Center, Rochester, NY.

Arch Surg. 1974;109(4):503-507. doi:10.1001/archsurg.1974.01360040025007

Twenty patients were seen with adynamic ileus of the colon, a condition characterized by massive gaseous distention of the large intestine in the absence of organic bowel obstruction. All except one patient had an associated major system disorder or operation that did not directly involve the gastrointestinal tract. Prominent abdominal distention was the prevailing clinical feature, and most patients also had signs and symptoms suggestive of mechanical obstruction of the large intestine. Diagnosis was generally made on the basis of the plain roentgenogram of the abdomen showing a marked and characteristically segmental dilation of the colon with a barium enema showing no obstructing lesion. There were three in-hospital deaths among the six patients managed nonoperatively, and three postoperative deaths among the 14 patients treated with a cecostomy. The one patient who developed a cecal perforation recovered following operation. Cecostomy is indicated when there is failure to improve within 72 hours or a cecal diameter greater than 12 cm.