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The recent advances in technology have made it possible to decompress acute pseudo-obstruction of the colon with colonoscope instead of celiotomy and cecostomy. Twenty-two patients who developed acute pseudo-obstruction of the colon and underwent colonoscopy were analyzed. The authors were successful in completely or partially decompressing the dilated colon in 19 of 22 patients. There were no complications. Acute pseudo-obstruction of the colon is usually secondary to intra- or extra-abdominal insult resulting in direct or reflex derangement of the sacral parasympathetic outflow. This causes a functional obstruction of the left colon. The goal of management is to prevent colonic perforation while treating the primary problems. Once the diagnosis has been made, colonoscopy should be attempted. Celiotomy should be reserved to cases in which colonoscopy is unsuccessful or in cases with perforation or impending perforation.
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