Large Intestine: 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