Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome)

Epidemiology

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Etiologic/Risk Factors

  • Aerophagia
  • Electrolyte Abnormality
  • Medications Which Impair Colonic Motility
  • Sepsis (see Sepsis, [[Sepsis]])

Physiology

  • Acute Marked Colonic Distention in the Absence of Defined Mechanical Pathology
    • May be referred to as “colonic Ileus”: however, pseudo-obstruction is limited to the colon alone (while ileus affects both the small bowel and the colon)
    • Pseudo-osbtruction may affect the right colon
    • Note: this is distinct from chronic intestinal pseudo-obstruction (see Chronic Intestinal Pseudo-Obstruction, [[Chronic Intestinal Pseudo-Obstruction]])

Diagnosis

  • KUB: isolated proximal colonic dilatation
  • Abdominal/Pelvic CT: isolated proximal colonic dilatation

Clinical Differentiation of Similar Entities

|Ileus|Pseudo-Obstruction|Bowel Obstruction
:————-:|:————-:|:———–:
Symp-toms|Mild abdominal pain, bloating, nausea, vomiting, obstipation, constipation|Crampy abdominal pain, constipation, obstipation, nausea, vomiting, anorexia|Crampy abdominal pain, constipation, obstipation, nausea, vomiting, anorexia
Exam|Silent abdomen, distention, tympanic|Borborygmi, tympanic, peristaltic waves, hypoactive or hyperactive bowel sounds, distention, localized tenderness|Borborygmi, peristaltic waves, high-pitched bowel sounds, rushes, distention, localized tenderness
X-Ray|Large and small bowel dilatation, diaphragm elevated|Isolated large bowel dilatation, diaphragm elevated|Bow-shaped loops in ladder pattern, paucity of colonic gas distal to lesion, diaphragm mildly elevated, air-fluid levels


Clinical Manifestations

Gastrointestinal Manifestations

  • Abdominal Distention: without abdominal pain or tenderness
    • Symptoms may mimic bowel obstruction
  • Colonic Ischemia (see Colonic Ischemia, [[Colonic Ischemia]])
  • Colonic Perforation (see Colonic Perforation, [[Colonic Perforation]])

Other Manifestations

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Treatment

Medical Therapy

  • Colonoscopic Decompression: effective
  • Correction of Electrolyte Abnormalities
  • Discontinuation of Medications Which Impair Bowel Motility
  • Intravenous Fluid Hydration
  • Nasogastric Tube: recommended
  • Neostigmine (see Neostigmine, [[Neostigmine]])
    • Administration: 2.5 mg IV over 3 min (with cardiac monitoring for bradycardia)
    • Adverse Effects
      • Bradycardia (see Bradycardia, [[Bradycardia]]): treat with atropine (see Atropine, [[Atropine]])
    • Clinical Efficacy: may result in resolution of pseudo-obstruction within 10-30 min
  • Rectal Tube: recommended

Surgical Therapy

  • Laparotomy with Bowel Resection/Ostomy: considered a last resort, but may be required in cases with bowel ischemia/peritonitis

Prognosis

  • Mortality Rate: 50% in cases with colonic ischemia/perforation

References

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