Ogilvie's syndrome

Background

• 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

Differential Diagnosis

Bowel obstruction

• Malignancy (commonly, colorectal cancer)
• Volvulus
• Diverticular disease
• Compression from metastatic disease
• Impaction
• Strictures (IBD, chronic colonic ischemia)
• Adhesions
• Hernia
• Toxic megacolon
• Ischemic colitis
• Adynamic ileus of the large and small bowel
• Abdominal pain ddx

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

Management

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:

• Emergent surgical consult
• Antibiotics

Disposition

• Admit

See Also

• Abdominal Pain
• Bowel Obstruction