Ogilvie's syndrome

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

• Signs, symptoms and radiographic appearance of acute large Bowel obstruction but no evidence of distal colonic obstruction
• Massively dilated colon (>10cm)
  • At risk for perforation, peritonitis and death

Differential Diagnosis

Bowel obstruction

Diagnosis

Work-up

• Same as bowel obstruction

Management

• Varies, requires surgical consultation
  • May resolve with conservative treatment or require colonoscopic decompression or operative management

Disposition

• Admission

References

• Rocco V. Acute and Chronic Constipation In: Tintinalli's Emergency Medicine. 7th ed. McGraw-Hill. 2011: Chapter 77