View source for Ogilvie's syndrome

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==Background==

*Also known as acute colonic pseudo-obstruction (ACPO)
*Defined as a [[Special:MyLanguage/large bowel obstruction|large bowel obstruction]] (LBO) in which no obstructing lesion can be identified
*No definite etiology identified: suspected to develop secondary to a disbalance of colonic autonomic regulatory control
*Predisposing factors: recent surgery, underlying neurologic disorders, critical illness
*First described in 1948 by Sir Ogilvie, in two patients with retroperitoneal malignancy and acute colonic pseudo-obstruction


==Clinical Features==


===History===

*Typically present in patients with concomitant acute comorbid conditions
**Commonly: significant spinal or retroperitoneal [[Special:MyLanguage/abdominal trauma|trauma]] 
**Also: significant [[Special:MyLanguage/electrolyte imbalances|electrolyte imbalances]], significant [[Special:MyLanguage/opioid|opioid]] exposure 
*Presenting signs and symptoms are the same as [[large bowel obstruction: 
**[[Abdominal pain|large bowel obstruction: 
**[[Special:MyLanguage/Abdominal pain]]/distension
**Obstipation
***In contrast to mechanical obstruction, 40-50% will continue to pass flatus
**[[Special:MyLanguage/Vomiting|Vomiting]]


===Physical Exam===

*Dilated bowel may be palpable
*Findings suggestive of [[Special:MyLanguage/dehydration|dehydration]], [[Special:MyLanguage/sepsis|sepsis]], and gangrene/perforation may be present, depending on the extent of progression 
*[[Special:MyLanguage/peritonitis|Peritoneal]] signs and fever suggest perforation


==Differential Diagnosis==

*Malignancy (commonly, colorectal cancer)
*[[Special:MyLanguage/diverticulitis|Diverticular disease]]
*Compression from metastatic disease
*Impaction
*Strictures (IBD, chronic colonic ischemia)
*Adhesions
*[[Special:MyLanguage/Hernia|Hernia]]
*[[Special:MyLanguage/Toxic megacolon|Toxic megacolon]]
*[[Special:MyLanguage/Ischemic colitis|Ischemic colitis]]
*Adynamic [[Special:MyLanguage/ileus|ileus]] of the large and small bowel

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==Evaluation==

[[File:Ogilvie ct coronal.jpg|thumb|CT-Scan showing a coronal section of the abdomen of an elderly woman with Ogilvie syndrome.]]

===Work-up===

Same as [[Special:MyLanguage/Bowel obstruction|bowel obstruction]]
*Labs:
**CBC: significant leukocytosis may indicate sepsis/gangrene/perforation
**Electrolyte Panel: guides rehydration 
*Imaging: See Clinical Features above
**[[Special:MyLanguage/Abdominal Xray|Abdominal Xray]]
***distended colon
***small bowel distension possible
***cecal diameter >12cm indicates high risk of perforation
**CT
***dilation of the large bowel, often without an abrupt transition point
***no mechanically obstructing lesion
***gradual transition point is commonly identified at or near the splenic flexure
**Water soluble contrast enema
***diagnostic: rules out mechanical obstruction
***may also be therapeutic
**Colonoscopy: also diagnostic and therapeutic


==Management==


===Cecal distention <12cm, no evidence of gangrene or perforation===

''consider conservative management''
*Surgical consult
*Bowel rest/decompression [NPO, [[Special:MyLanguage/NG tube|NG tube]], rectal tube]
*[[Special:MyLanguage/volume repletion|Rehydration]]/[[Special:MyLanguage/Electrolyte repletion|Electrolyte repletion]]
*[[Special:MyLanguage/analgesia|Pain management]] [No opioids]
*Management of comorbid conditions
*[[Special:MyLanguage/Neostigmine|Neostigmine]] then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases
**Neostigmine for cecal diameter >10cm
**2-2.5mg neostigmine IV over 5min<ref>Maloney N and Vargas HD. Acute Intestinal Pseudo-Obstruction (Ogilvie's Syndrome). Clin Colon Rectal Surg. 2005 May; 18(2): 96–101.</ref>
**Exclude patient with HR<60, low SBP, peritoneal signs


===Cecal distension >12cm '''OR''' evidence of gangrene/perforation===

*Emergent surgical consult
*[[Special:MyLanguage/Antibiotics|Antibiotics]]


==Disposition==

*Admit


===Complications===

*Untreated, Ogilvie’s Syndrome leads to the same pathologic changes as any mechanical large bowel obstruction: increasing bowel dilation and distension, dehydration, edema and eventual ischemia and necrosis of the bowel wall, bacterial translocation and sepsis, and eventual bowel wall perforation. 
*Cecal perforation is rare: 1-3%


==See Also==

*[[Special:MyLanguage/Abdominal Pain|Abdominal Pain]]
*[[Special:MyLanguage/Bowel Obstruction|Bowel Obstruction]]


==External Links==


==References==

<references/>


[[Category:GI]]
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