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Ogilvie's syndrome (colonic pseudo-obstruction)

Etiology: 1) trauma (10%) a) spine b) retroperitoneum 2) surgery: - orthopedic surgery, cardiac surgery, thoracic surgery, spinal surgery 2) infection (10%) 3) cardiac disease (10%) a) myocardial infarction b) congestive heart failure 4) narcotic administration common 5) end-stage liver disease with portosystemic encephalopathy [2] 6) severe illness [4] 7) 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: 1) nausea/vomiting 2) abdominal pain 3) constipation 4) diarrhea (paradoxical) 5) abdominal distension invariably present may result in dyspnea 6) bowel sounds present in 90% Laboratory: 1) serum sodium: hyponatremia 2) serum calcium: hypocalcemia 3) serum magnesium: hypomagnesemia 4) serum potassium: hypokalemia Radiology: 1) plain abdominal film shows dilated colon [2] 2) daily abdominal radiographs 3) 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] - distension 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: 1) supportive care - intravenous fluids - nasogastric & rectal tubes [2] 2) discontinuation of offending agents a) opiates b) anticholinergic agents 3) enema 4) pharmaceutical agents to stimulate bowel motility a) neostigmine 1.5-2.0 g IV most effective for acute decompression [3] b) erythromycin 250 mg IV every 8 hours (limited effectiveness) [3] c) prucalopride for refractory pseudo-obstruction [3] 5) colonoscopic decompression [2] - indications: - failure of conservative management - colonic ischemic - colonic perforation - peritonitis

General

syndrome

References

  1. UpToDate Online 11.2 2003 http://www.uptodate.com
  2. Alahdab F, Saligram S Acute Colonic Pseudo-Obstruction. N Engl J Med 2015; 372:e5. January 22, 2015. PMID: 25607448 http://www.nejm.org/doi/full/10.1056/NEJMicm1311399
  3. 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. NEJM Knowledge+ Gastroenterology