Acute colonic pseudo obstruction (ACPO) is a rare but life threatening condition of massive colonic dilatation in the absence of mechanical obstruction. It occurs almost exclusively in patients with one or more underlying medical conditions, including (abdominal) surgery and spinal cord trauma, but also malignancy, infection, electrolyte imbalances, medication (especially chemotherapy) and neurologic disorders. Consensus on what diagnostic modalities are required for the diagnosis of ACPO is lacking. True incidence of ACPO is lacking but it is estimated that it may occur after surgery in up to 0.06% of patients . Bowel ischemia and perforation secondary to ACPO are feared complications, occurring in 3–15% of patients and cause a high mortality rate of up to 50% . The differential diagnosis consists of mechanical obstruction, ischemia and toxic megacolon due to Clostridium difficile. Patients may experience pain, nausea, vomiting, constipation, sometimes paradoxical (overflow) diarrhea, and a dilated, painful abdomen, without guarding. Bowel sounds may not be present. Plain abdominal radiography shows a markedly distended colon with normal haustral markings, however CT will nowadays be the investigation of choice.
