Ogilvie's syndrome (colonic pseudo-obstruction)
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Etiology
- trauma (10%)
- surgery:
- infection (10%)
- cardiac disease (10%)
- narcotic administration common
- end-stage liver disease with portosystemic encephalopathy[2]
- severe illness[4]
- idiopathic[3]
Epidemiology
- rare, 1 case per 1000 hospital admissions[3]
Pathology
- interruption of parasympathetic fibers S2-S4 results in atonic distal colon & functional proximal obstruction (some patients)
- cecum & right ascending colon most often involved[3]
* image[3]
Clinical manifestations
- nausea/vomiting
- abdominal pain
- constipation
- diarrhea (paradoxical)
- abdominal distension invariably present may result in dyspnea
- bowel sounds present in 90%
Laboratory
- serum sodium: hyponatremia
- serum calcium: hypocalcemia
- serum magnesium: hypomagnesemia
- serum potassium: hypokalemia
Radiology
- plain abdominal film shows dilated colon[2]
- daily abdominal radiographs
- computed tomography of abdomen confirms impression of plain abdominal film[2]
- absence of obstructing lesions[4]
* images[3]
Complications
- massive dilation of colon, especially cecum
- colonic perforation, especially cecum
- cecum diameter > 10 cm threshold for colonic ischemia & colonic perforation[3]
- distention of cecum for > 6 days is risk factor[3]
Differential diagnosis
- toxic megacolon
- often associated with inflammatory bowel disease or C difficile colitis[4]
- systemic symptoms: fever, tachycardia, altered mental status[4]
- Hirschsprung disease
Management
- supportive care
- intravenous fluids
- nasogastric & rectal tubes[2]
- discontinuation of offending agents
- enema
- pharmaceutical agents to stimulate bowel motility
- neostigmine 1.5-2.0 g IV most effective for acute decompression[3]
- erythromycin 250 mg IV every 8 hours (limited effectiveness)[3]
- prucalopride for refractory pseudo-obstruction[3]
- colonoscopic decompression[2]
- indications:
- failure of conservative management
- colonic ischemic
- colonic perforation
- peritonitis
- indications:
More general terms
References
- ↑ UpToDate Online 11.2 2003 http://www.uptodate.com
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Alahdab F, Saligram S Acute Colonic Pseudo-Obstruction. N Engl J Med 2015; 372:e5. January 22, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25607448 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1311399
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Musa A, Geimadi A, Georgis MT et al Ogilvie Syndrome (Acute Colonic Pseudo-obstruction): Early Recognition and Treatment Are Key. Medscape. Nov 18, 2022 https://reference.medscape.com/slideshow/ogilvie-syndrome-6014904
- ↑ 4.0 4.1 4.2 4.3 4.4 NEJM Knowledge+ Gastroenterology