Pseudo-obstruction of the colon as a complication in hip surgery

Pseudo-obstruction of the colon is characterized by a massive colonic dilat ation without mechanical obstruction. It is rarely after hip surgery, howev er, untreated it may be complicated by a life threatening perforation of th e colon. In a retrospective analysis we reviewed 11 patients (4 women, 7 me n, mean age 75.2 years, range 67 to 86 years) with pseudo-obstruction of th e colon after hip surgery in the years 1995 to 1998. In relation to all pat ients aged 65 years and older who underwent surgery of the hip,the prevalen ce was 1.06%. The leading clinical symptom was abdominal distension. On pla in x-rays, dilatation of the colon measured 13.3 cm on average (9-16 cm). I n two patients (18%) adaequate application of drugs stimulating the gastro- intestinal motility was sufficient, whereas in 8 patients (73%) colonoscopi c decompression had to be performed. In three of these, the procedure faile d and because of persistent symptoms a coecostomy was performed. One patien t underwent immediate laparotomy because of peritonitis. 2 patients (18%) d ied because of a complicated course. Non operative treatment should not exc eed 24 hours, endoscopic decompression and tube placement is considered as the treatment of choice. In cases of failure of these procedures, perforati on of the colon and/or peritonism, urgent laparotomy with open decompressio n by a coecostomy is essential.