at laparotomy. The clinical picture is one of increasing abdominal distension, crampy abdominal pain, constipation or diarrhoea, vomiting, normal or obstructive bowel sounds, and a distended colon with fluid levels on x-ray examination. It is usually associated with intra-abdominal or generalized disease. Dudley et al.3 and Stephens45 called it "intestinal pseudo-obstruction." It has also been termed "idiopathic large bowel obstruction,"6 "ileus of the colon,"7 and "spastic ileus."8 910 The variety of names illustrates well the divergence of thought on this condition. Four further cases of large bowel pseudo-obstruction are described here and a detailed review is made of the literature. We have favoured the term pseudo-obstruction, as it is descriptive but not too specific.