Insertion of a decompression tube to the proximal colon under direct colonoscopic visual guidance in acute colonic pseudo-obstruction

Acute colonic pseudoobstruction (ACPO) is a medical emergency defined as acute colonic distention without mechanical obstruction or inflammatory status. The initial treatment for ACPO includes conservative therapy and gastrointestinal tube decompression. Colonic endoscopic decompression is indicated in patients who fail to respond to conservative treatment. If none of the above treatments are effective, surgeries such as cecostomy must be considered. We report the case of a 77-year-old man with a history of Parkinson's disease who was receiving anti-Parkinson agent therapy. The patient presented with abdominal distention for 1 week, and ACPO was diagnosed. The patient received conservative treatment after admission; however, the symptoms and imaging findings did not improve. Endoscopic decompression was unsuccessful. Subsequently, we successfully treated the patient with a novel technique by placing a decompression tube into the proximal colon under the guidance of a colonoscope.