RadioGraphics, Vol 6, 995-1005, Copyright © 1986 by Radiological Society of North America
Pseudoobstruction in the geriatric population
YT Adler, KG Draths and WS Markey
Department of Diagnostic Radiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
In this time of sophisticated technology, the diagnosis of intestinal
obstruction and pseudoobstruction still depends on plain radiographs and
barium studies. Old myths and rigid routines interfere with the
interpretation of plain radiographic examinations, however. Air-fluid
levels can be present in the colon owing to fluid accumulation from
prolonged stasis, and they do not necessarily indicate obstruction.
Positioning of the patient for diagnostic studies should be directed so
that the shifting of gas within the colon gives maximal information about
intestinal patency and diameter. Barium studies are only necessary and
desirable when the gas pattern suggests a mechanical obstruction.
Pseudoobstruction, which tends to be amenable to conservative treatment, is
a frequent occurrence in the elderly population. If properly managed, the
risk of perforation is low, and invasive procedures can usually be avoided.
In the elderly population with poor intestinal tone, colonic caliber is
often large; yet some textbooks still quote specific cecal diameters as
indicators of impending perforation. Mobilizing the gas with positional
maneuvers can help to decrease cecal size, facilitate evacuation, and allay
fear. This is one more situation in which the radiologist can play an
active role in patient management. Close cooperation with the clinician is
necessary to insure optimal care of these difficult and challenging
patients.
