The clinical knowledge of ACPO (acute colorectal pseudo-obstruction) is progressively improving but there is a lot of further studies to be done; the diagnosis and treatment are still a challenge for clinical practitioners. With respect to the deep understanding of ACPO, etiology and epidemiology are also undergoing changes. ACPO should be alerted in patients with intestinal obstruction and mechanical obstruction should be ruled out through imaging studies. Early diagnosis is the key, conservative treatment can be tried as the next step in management but the concentration of drug needs to be ensured. There is need for research to be done about new drugs for ACPO and prevent its? relapse. Endoscopic treatment is feasible when met with contraindications for drug treatment or poor efficacy of drugs; new technologies of endoscopy such as vacuum tube or endoscopic cecal gastrostomy have provided effective clinical effect. The last resort of treatment is surgical intervention but it is accompanied with high mortality and complications. Therefore, clinicians should be fully aware of all treatment methods; comprehensive use of conservative treatment and endoscopy for the welfare of the patients.