Which statement best distinguishes colonic pseudo-obstruction from mechanical obstruction?

• A. There Is No Evidence Of a Mechanical Blockage On Imaging
• B. It Is Always Caused By a Physical Blockage
• C. It Requires Immediate Surgical Intervention In All Cases
• D. It Presents With Fever And Leukocytosis

Answer: (A)

Colonic pseudo-obstruction presents with marked dilation of the colon due to impaired motility, not a physical blockage. The defining clue is imaging: there is no discrete obstructing lesion or transition point seen. In a true mechanical obstruction, imaging would reveal a specific site of blockage with proximal dilation and an abrupt cutoff. Fever and leukocytosis are not specific distinguishing features, and surgery is not immediately required in all cases of pseudo-obstruction. Because there’s no mechanical barrier, the approach is typically conservative and focused on correcting underlying causes, with decompression considered if needed. Therefore, the statement that there is no evidence of a mechanical blockage on imaging best distinguishes colonic pseudo-obstruction from mechanical obstruction.