529 Acute Colonic Pseudo-Obstruction: A Critical Complication in Burn Patients

Abstract

\n \n \n Acute Colonic Pseudo-Obstruction (ACPO) is a rare clinical condition characterized by gross dilation of the large bowel in the absence of an obstruction. It presents a particularly complex challenge in diagnosis and management in the context of burn trauma. We followed five burn patients who developed ACPO that did not respond to conservative treatments. These patients ultimately required surgical intervention to resolve their ACPO. Through our study, we propose that traditional management may not be successful in fully treating ACPO in burn patients without recurrence and that complete resolution necessitates a more aggressive management course, often in the form of surgical intervention.\n \n \n \n We studied the clinical course of all burn patients who developed ACPO in the past 2 years at our burn center. Using Electronic Health Records, we collected patient demographic data, percent total burn surface area (%TBSA), hospital length of stay, cecal diameter, bowel regimen for catharsis, and vital sign measurements. Abdominal CT scans and X-rays were used to monitor the progression of cecal diameter.\n \n \n \n We have noted that burn patients who are at a high risk of developing ACPO tend to either be obese, have large TBSA burns (>20%), or have a combination of both. Furthermore, patients who had a greater percentage of 3rd degree burns had worse outcomes. All patients received acetylcholinesterase inhibitors (AChEi’s), but ultimately underwent some manner of further intervention for complete resolution of ACPO. Two patients were treated solely with decompression: one via NGT suction, the other via colonoscope. Three patients received surgical intervention through hemicolectomy, subtotal colectomy, and cecostomy. The former two subsequently expired, one due to direct ACPO complications; the latter three survived and remain well today.\n \n \n \n ACPO is a rare but serious complication in burn patients that may easily be missed by the diagnosing clinician. In the treatment of ACPO in burn patients, one should consider a more aggressive approach, as traditional medical therapy may not be enough to resolve the original distention or prevent a recurrence. In our review of five burn patients that subsequently developed ACPO, surgical intervention was universally the mechanism by which definitive resolution of the condition was achieved.\n