Ogilvie's syndrome: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Work-up=== | ===Work-up=== | ||
Same as [[Bowel obstruction|bowel obstruction]] | |||
*Labs: | |||
**CBC: significant leukocytosis may indicate sepsis/gangrene/perforation | |||
**Electrolyte Panel: guides rehydration | |||
*Imaging: See Clinical Features above | |||
**Abdominal XR | |||
**CT | |||
**Water soluble contrast enema | |||
**Colonoscopy | |||
===Evaluation=== | ===Evaluation=== | ||
Revision as of 19:37, 30 August 2015
Background
- Ogilvie syndrome is also known as acute colonic pseudo-obstruction (ACPO)
- Defined as a 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 trauma
- Also: significant electrolyte imbalances, significant narcotic exposure
- Presenting signs and symptoms are the same as LBO: abdominal pain, distension, obstipation, vomiting
- In contrast to mechanical obstruction, 40-50% will continue to pass flatus
Physical Exam:
- Dilated bowel may be palpable
- Findings suggestive of dehydration, sepsis, and gangrene/perforation may be present, depending on the extent of progression
- Peritoneal signs and fever suggest perforation
Imaging:
- Abdominal XR:
- 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
Differential Diagnosis
Diagnosis
Work-up
Same as bowel obstruction
- Labs:
- CBC: significant leukocytosis may indicate sepsis/gangrene/perforation
- Electrolyte Panel: guides rehydration
- Imaging: See Clinical Features above
- Abdominal XR
- CT
- Water soluble contrast enema
- Colonoscopy
Evaluation
Management
- Varies, requires surgical consultation
- May resolve with conservative treatment or require colonoscopic decompression or operative management
Disposition
- Admission
See Also
External Links
References
- Rocco V. Acute and Chronic Constipation In: Tintinalli's Emergency Medicine. 7th ed. McGraw-Hill. 2011: Chapter 77