Acute colonic pseudo-obstruction (Ogilvie's syndrome)
- Michael Camilleri, MD
Michael Camilleri, MD
- Professor of Medicine, Pharmacology, and Physiology
- Mayo Clinic College of Medicine
Pseudo-obstruction is characterized by signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of a mechanical cause. Pseudo-obstruction may be acute or chronic and is characterized by the presence of dilation of the bowel on imaging. Other causes of colonic distension including toxic megacolon, mechanical obstruction, and chronic intestinal pseudo-obstruction are discussed in detail, separately. (See "Overview of mechanical colorectal obstruction" and "Toxic megacolon" and "Chronic intestinal pseudo-obstruction".)
Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a disorder characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents.
Acute colonic pseudo-obstruction usually occurs in hospitalized or institutionalized patients in association with a severe illness or after surgery and in conjunction with a metabolic imbalance or administration of culprit medication (table 1) [1-4]. In a large, retrospective series that included 400 patients with acute colonic pseudo-obstruction, the most common predisposing conditions were nonoperative trauma, infection, and cardiac disease, each of which were associated with 10 percent of cases . In this series, cesarean section and hip surgery were the most common surgical procedures associated with acute colonic pseudo-obstruction.
Acute colonic pseudo-obstruction usually involves the cecum and right hemicolon, although occasionally colonic dilation extends to the rectum. Acute colonic pseudo-obstruction appears to be more common in men and in patients over the age of 60 years . However, cases have been reported in children . Acute colonic pseudo-obstruction is a rare complication of surgery, occurring in 0.06 percent of patients after cardiac surgery, 0.29 percent of burn patients, and 0.7 to 1.3 percent of patients after orthopedic surgery [4,6]. In surgical patients, symptoms usually present at an average of five days postoperatively.
The precise mechanism by which colonic dilation occurs in patients with acute colonic pseudo-obstruction is unknown. The association with trauma, spinal anesthesia, and pharmacologic agents suggests an impairment of the autonomic nervous system. Interruption of the parasympathetic fibers from S2 to S4 leaves an atonic distal colon and a functional proximal obstruction [1,7]. However, there is no proposed mechanism to explain colonic dilation in those patients without obvious involvement of the parasympathetic nerves.
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- CLINICAL MANIFESTATIONS
- - Laboratory tests
- - Imaging
- DIFFERENTIAL DIAGNOSIS
- Mechanical obstruction
- Toxic megacolon
- Approach to management
- Supportive care
- Nonsurgical decompression
- - Colonoscopic decompression
- - Percutaneous decompression
- SUMMARY AND RECOMMENDATIONS