Ogilvie's syndrome: Difference between revisions

Revision as of 07:21, 31 August 2015

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

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

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

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

Cecal distention <12cm, no evidence of gangrene or perforation: consider conservative management

Surgical consult
Bowel rest/decompression [NPO, NG tube, Rectal tube]
Rehydration/Electrolyte Repletion
Pain management [No narcotics]
Management of comorbid conditions
Neostigmine then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases

Cecal distension >12cm or evidence of gangrene/perforation:

Authors:

@@ Line 7: / Line 7: @@
 ==Clinical Features==
-'''History''':
+===History===
 *Typically present in patients with concomitant acute comorbid conditions
 **Commonly: significant spinal or retroperitoneal trauma
@@ Line 14: / Line 14: @@
 **In contrast to mechanical obstruction, 40-50% will continue to pass flatus
-'''Physical Exam''':
+===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
-'''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%
 ==Differential Diagnosis==