HWN Suggests

Acute colonic pseudo-obstruction (Ogilvie’s syndrome)

As long as the patient is stable, does not have peritoneal signs on exam, and the cecal size is less than 12 cm, the management is conservative. This includes correcting electrolytes, correcting fluid imbalances, and stopping oral intake. Any medications that can slow colonic motility, such as opioids and anticholinergics, should be discontinued. Nasogastric tubes are generally recommended, but given the lack of evidence in mechanical obstruction and the fact that they are rated as among the most painful things we do to patients, I would probably skip it initially. Keeping patients out of bed and walking is also essential (so don’t tether them with an unnecessary foley or IV line).

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Articles of Interest

Acute colonic pseudo-obstruction

Acute colonic pseudo-obstruction (ACPO or Ogilvie syndrome) is an under-recognized disorder characterized by acute and extensive dilatation of the colon in the absence of an anatomic lesion obstructing the gastrointestinal tract. The condition is uncommon, however it is vital to recognize as, untreated, it is potentially lethal.

Acute colonic pseudo-obstruction (ACPO; Oglivie’s syndrome)

Acute colonic pseudo-obstruction refers to a paralytic ileus of the colon which causes severe colonic dilation. In some cases the small bowel may also be involved... More commonly, colonic pseudo-obstruction develops as a nosocomial complication. For example, As a postoperative complication (especially following orthopedic or gastrointestinal surgery, with prolonged immobility). Arising in the context of mechanical ventilation (especially among patients on continuous infusion of opioid analgesia).

Ogilvie syndrome: acute pseudo-obstruction of the colon

Unlike toxic megacolon (often caused by inflammatory bowel disease or infection), Ogilvie syndrome usually does not present with signs of systemic toxicity. Computed tomography is usually indicated for ruling out obstructive lesions or possible bowel ischemia. If the syndrome is left untreated, life-threatening complications such as bowel ischemia or perforation may occur in an estimated 3%–15% of patients, with a 50% reported mortality rate.

Ogilvie’s Syndrome

Another zebra came close to running me over the other day. Let us take a minute to review Colonic Pseudo-Obstruction, Ogilvie’s Syndrome.

What is Ogilvie syndrome (Acute Colonic Pseudo-Obstruction)?

Ogilvie syndrome is characterized by the dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction, often occurring in debilitated patients. The pathophysiology is still poorly understood, but it is believed to involve imbalances in the autonomic nervous system that regulates bowel function.

Resources

Abdominal Key

Treatment options for ACPO include appropriate supportive measures, medical therapy, colonoscopic decompression, and surgery. Despite extensive literature documenting the clinical features of ACPO, there are very few randomized controlled clinical trials on the treatment of this condition, and most evidence for efficacy of treatments comes from uncontrolled studies.

Consultant360

Ogilvie syndrome is characterized by gross dilatation of the cecum and right hemicolon that may extend to the rectum in the absence of intestinal obstruction. The exact mechanism is unknown; however, an impairment of the autonomic nervous system has been suspected. Associated conditions include malignancy, trauma, infection, cardiac disease, major surgeries, severe illness, electrolyte imbalance (especially hypokalemia, hypocalcemia, or hypomagnesemia), and use of certain medications (eg, narcotics, phenothiazines, calcium channel blockers, α2-adrenergic agonists, epidural analgesics).

National Library of Medicine

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a condition characterized by massive colonic distension in the absence of mechanical obstruction. Patients presenting with Ogilvie's syndrome have underlying medical and surgical conditions predisposing them to the syndrome. Ogilvie's syndrome can often be managed by conservative therapy. However, unrecognized and untreated, the continued distension associated with Ogilvie's syndrome can lead to perforation that is associated with a high mortality rate.

StatPearls

Acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome, is a distinct form of colonic dilatation without underlying mechanical or anatomic etiology. Dilatation of the bowel is classically confined to the cecum and ascending colon with a transition near the splenic flexure. It is most commonly encountered in older adults with multiple underlying comorbidities but may also develop in otherwise healthy patients after a traumatic injury or following a surgical operation.