Large Intestine: Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome)

Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome)

Basics

  • Acute Colonic Dilation in the Absence of Mechanical Obstruction
  • Mortality Risk: 8%
    • 40-45% if Perforated
  • High-Risk for Perforation:
    • Cecum > 10-12 cm
    • Duration > 6 Days

Risk Factors

  • Elderly
  • Acute Medical Illness – Infection or Cardiac Disease Most Common
  • Opiates
  • Nonoperative Trauma
  • Surgery – Cesarean Section & Hip Surgery Most Common

Presentation

  • Abdominal Distention – Primary Clinical Feature
  • Abdominal Pain
  • Nausea & Vomiting
  • Diarrhea or Constipation

Diagnosis

  • Dx: CT
    • Proximal Dilation Extending from the Cecum
    • Extends to:
      • Hepatic Flexure: 17%
      • Splenic Flexure: 56%
      • Left Colon: 27%
    • Can Monitor with Abdominal XR – Nonspecific for Dx

Treatment

  • < 10-12 cm Diameter: Bowel Rest
    • Serial Abdominal Examination & Abdominal XR
    • Consider Methylnaltrexone (Relistor) if Opiate-Induced
      • GI Tract Specific Opioid Antagonist
  • > 10-12 cm Diameter or Fails After 48-72 Hours: Neostigmine
    • 85-90% Success Rate
    • *Monitor for Bradycardia
  • If Neostigmine Contraindicated or Fails: Endoscopic Decompression
    • May Consider Second Dose of Neostigmine After 24 Hours
    • Consider Leaving a Tube for Continued Decompression
  • If Endoscopic Decompression Fails: Cecostomy Tube
    • Can Be Performed by Colonoscopy, Interventional Radiology or Surgery
  • Surgery Indications: Ischemia or Perforation

Ogilvie’s Syndrome

Ogilvie’s Syndrome